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General NPI Number Information
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NPI Number | 1144785098
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Entity Type | Organization
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Legal Business Name | FC OHIO, LLC
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 2006 MICHIGAN ST
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City | SIDNEY
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State | OH
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Zip | 45365-9069
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Country | US
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Telephone | 937-419-4944
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Fax | 937-419-4945
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Provider Business Mailing Address
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Address Line | PO BOX 40166
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City | NASHVILLE
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State | TN
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Zip | 37204-0166
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Country | US
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Telephone | 615-600-3447
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Fax | 877-471-4152
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ANDREW MICHAEL DEANE
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Credential |
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Telephone | 615-600-3478
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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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