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General NPI Number Information
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NPI Number | 1447328067
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Entity Type | Organization
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Legal Business Name | MAPLE LEAF FAMILY AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 2211 TIMBER TRAIL
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City | BELLEFONTAINE
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State | OH
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Zip | 43311
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Country | US
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Telephone | 937-592-3808
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Fax | 937-593-8404
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Provider Business Mailing Address
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Address Line | 2211 TIMBER TRAIL
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City | BELLEFONTAINE
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State | OH
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Zip | 43311
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Country | US
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Telephone | 937-592-3808
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Fax | 937-593-8404
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Authorized Official
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Title or Position | PARTNER
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Name | DR. BOYD C HODDINOTT
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Credential | MD
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Telephone | 937-592-3808
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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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