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General NPI Number Information
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NPI Number | 1114642907
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Entity Type | Organization
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Legal Business Name | OLD TYME FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 57 W HIGH ST
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City | LONDON
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State | OH
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Zip | 43140-1050
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Country | US
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Telephone | 740-490-7100
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Fax | 740-490-7055
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Provider Business Mailing Address
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Address Line | PO BOX 138
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City | LEWIS CENTER
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State | OH
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Zip | 43035
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Country | US
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Telephone | 740-490-7100
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Fax | 740-490-7055
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MORGAN STEISKAL
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Credential | APRN, FNP
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Telephone | 740-490-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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