Healthcare Provider Details

I. General information

NPI: 1588654230
Provider Name (Legal Business Name): AUGLAIZE FAMILY PRACTICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W AUGLAIZE ST
WAPAKONETA OH
45895-1351
US

IV. Provider business mailing address

PO BOX 359
WAPAKONETA OH
45895-0359
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-9601
  • Fax: 419-941-1368
Mailing address:
  • Phone: 419-738-9601
  • Fax: 419-941-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. AMY DALE HOYT
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-738-9680