Healthcare Provider Details

I. General information

NPI: 1124014261
Provider Name (Legal Business Name): HOSPITALIST SERVICES MEDICAL GROUP OF SPRINGFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 SCIOTO ST
URBANA OH
43078-2226
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-5231
  • Fax: 937-563-7551
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1430089
License Number StateOH

VIII. Authorized Official

Name: PAUL W KOLODZIK
Title or Position: COO
Credential: MD
Phone: 800-726-3627