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General NPI Number Information
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NPI Number | 1205014438
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Entity Type | Organization
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Legal Business Name | PLATT FAMILY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 530 W UNION ST SUITE B
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City | ATHENS
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State | OH
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Zip | 45701-8303
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Country | US
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Telephone | 740-594-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 530 W UNION ST SUITE B
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City | ATHENS
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State | OH
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Zip | 45701-8303
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Country | US
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Telephone | 740-594-7050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM J PLATT
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Credential | DO
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Telephone | 740-594-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 34 004801
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License Number State | OH
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