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General NPI Number Information
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NPI Number | 1295196087
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Entity Type | Organization
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Legal Business Name | HICKORY MEDICAL DIRECT PRIMARY CARE, LLC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 208 W COLUMBUS AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1434
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Country | US
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Telephone | 937-404-2488
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Fax | 937-404-2428
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Provider Business Mailing Address
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Address Line | 208 W COLUMBUS AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1434
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Country | US
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Telephone | 937-404-2488
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Fax | 937-404-2428
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. RYAN D KAUFFMAN
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Credential | MD
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Telephone | 937-404-2488
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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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