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General NPI Number Information
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NPI Number | 1245324193
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Entity Type | Organization
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Legal Business Name | MOUND FAMILY PRACTICE ASSOC INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 1012 E CENTRAL AVE
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City | MIAMISBURG
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State | OH
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Zip | 45342-2556
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Country | US
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Telephone | 937-866-0741
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Fax | 937-866-8861
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Provider Business Mailing Address
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Address Line | 20 N RIDGE
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City | SPRINGBORO
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State | OH
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Zip | 45066-9283
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Country | US
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Telephone | 937-748-2699
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM BRENT ASHCRAFT
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Credential | M.D.
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Telephone | 937-866-0741
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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 | OH
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