=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598734170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUE E ADAMS D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 CAMPBELL DR
-----------------------------------------------------
City | IRONTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45638-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-534-9202
-----------------------------------------------------
Fax | 740-532-4777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 N 5TH ST
-----------------------------------------------------
City | IRONTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45638-1578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-532-4858
-----------------------------------------------------
Fax | 740-532-4859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34006672
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------