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General NPI Number Information
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NPI Number | 1497711055
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Entity Type | Organization
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Legal Business Name | FAMILY & SPORTS MEDICINE, INC
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 110 SELHORST DR
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City | OTTAWA
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State | OH
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Zip | 45875-1561
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Country | US
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Telephone | 419-523-6329
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Fax | 419-523-3960
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Provider Business Mailing Address
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Address Line | 110 SELHORST DR
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City | OTTAWA
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State | OH
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Zip | 45875-1561
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Country | US
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Telephone | 800-204-0099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN BIERY
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Credential | DO
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Telephone | 419-523-6329
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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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