Healthcare Provider Details

I. General information

NPI: 1194288514
Provider Name (Legal Business Name): YELLOW SPRINGS PRIMARY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 DAYTON ST UNIT 106
YELLOW SPRINGS OH
45387-1778
US

IV. Provider business mailing address

888 DAYTON ST UNIT 106
YELLOW SPRINGS OH
45387-1778
US

V. Phone/Fax

Practice location:
  • Phone: 937-767-1088
  • Fax: 937-767-1022
Mailing address:
  • Phone: 937-767-1088
  • Fax: 937-767-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONALD ALEXANDER GRONBECK
Title or Position: OWNER
Credential: MD
Phone: 937-767-1088