=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013161215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL OCCUPATIONAL HEALTH CLINICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2008
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1835 E HIGH ST STE 2
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45505-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-322-8977
-----------------------------------------------------
Fax | 937-322-5837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1835 E HIGH ST STE 2
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45505-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-322-8977
-----------------------------------------------------
Fax | 937-322-5837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. ANGELIA K MONTGOMERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-322-8977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------