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General NPI Number Information
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NPI Number | 1114354081
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Entity Type | Organization
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Legal Business Name | EMMA L BIXBY MEDICAL CENTER
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 5855 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-2269
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Country | US
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Telephone | 419-824-7334
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Fax | 419-824-7359
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Provider Business Mailing Address
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Address Line | 5855 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-2269
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Country | US
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Telephone | 419-824-7334
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Fax | 419-824-7359
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Authorized Official
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Title or Position | CREDENTIAILNG SUPERVISOR
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Name | AMY L DWYER
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Credential |
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Telephone | 419-824-7334
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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 |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | MI
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