Healthcare Provider Details

I. General information

NPI: 1982600862
Provider Name (Legal Business Name): MEDICAL SERVICE ASSOCIATES OF XENIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PROGRESS DR
XENIA OH
45385-2666
US

IV. Provider business mailing address

1141 N MONROE DR
XENIA OH
45385-1619
US

V. Phone/Fax

Practice location:
  • Phone: 937-372-7691
  • Fax: 937-374-4020
Mailing address:
  • Phone: 937-352-2787
  • Fax: 937-352-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD DRENTH
Title or Position: DIRECTOR PHYSICIAN PRACTICES
Credential:
Phone: 937-352-2788