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General NPI Number Information
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NPI Number | 1225159791
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Entity Type | Organization
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Legal Business Name | WEST MARKET STREET FAMILY PHYS
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 915 W MARKET ST SUITE E
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City | LIMA
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State | OH
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Zip | 45805-2768
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Country | US
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Telephone | 419-229-4747
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Fax | 419-224-3348
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Provider Business Mailing Address
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Address Line | 915 W MARKET ST SUITE E
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City | LIMA
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State | OH
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Zip | 45805-2768
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Country | US
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Telephone | 419-229-4747
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Fax | 419-224-3348
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J NEIDHARDT
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Credential | M.D.
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Telephone | 419-229-4747
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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 |
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