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General NPI Number Information
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NPI Number | 1164839726
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Entity Type | Organization
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Legal Business Name | OBSERVATION MEDICINE PHYSICIANS OF CHAMPAIGN COUNTY, LTD
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER DR
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2687
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Country | US
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Telephone | 937-523-1461
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Fax | 937-523-1590
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Provider Business Mailing Address
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Address Line | 4535 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718-2545
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Country | US
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Telephone | 330-493-4443
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Fax | 330-493-8677
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID SCOTT
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Credential | MD
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Telephone | 330-493-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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