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General NPI Number Information
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NPI Number | 1588659841
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Entity Type | Organization
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Legal Business Name | HOSPITAL SERVICES MEDICAL GROUP OF CLARK COUNTY INC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2615 E HIGH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-1412
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Country | US
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Telephone | 937-325-0531
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 HEMPSTEAD STATION DR
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City | KETTERING
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State | OH
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Zip | 45429-5164
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Country | US
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Telephone | 800-875-0136
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Fax | 937-619-4342
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Authorized Official
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Title or Position | COO
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Name | PAUL W KOLODZIK
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Credential | MD
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Telephone | 800-726-3627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1429529
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License Number State | OH
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