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General NPI Number Information
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NPI Number | 1083799357
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Entity Type | Organization
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Legal Business Name | LIFE MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 80 TROY TOWN DR
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City | TROY
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State | OH
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Zip | 45373-2328
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Country | US
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Telephone | 937-681-5740
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4428
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City | SIDNEY
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State | OH
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Zip | 45365-4428
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MRS. JULIE RENEE GRAWE
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Credential |
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Telephone | 937-681-5740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35067724
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License Number State | OH
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