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General NPI Number Information
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NPI Number | 1366686230
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Entity Type | Organization
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Legal Business Name | SOMC MEDICAL CARE FOUNDATION, INC.
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-356-8117
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Fax | 740-353-1214
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Provider Business Mailing Address
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Address Line | 1735 27TH ST WALLER BUILDING, SUITE B06
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2677
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Country | US
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Telephone | 740-356-8681
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Fax | 740-356-1256
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. REBECCA L FITE
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Credential |
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Telephone | 740-356-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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