Healthcare Provider Details

I. General information

NPI: 1114664836
Provider Name (Legal Business Name): OHIO VALLEY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 TROY RD
SPRINGFIELD OH
45504-4328
US

IV. Provider business mailing address

100 W MAIN ST
SPRINGFIELD OH
45502-1312
US

V. Phone/Fax

Practice location:
  • Phone: 937-340-6440
  • Fax: 937-340-6441
Mailing address:
  • Phone: 937-521-3900
  • Fax: 937-521-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MENDY WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 937-717-2261