=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649315912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHRISTIAN CHURCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 E SANDUSKY AVE
-----------------------------------------------------
City | BELLEFONTAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43311-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-592-8656
-----------------------------------------------------
Fax | 937-592-7705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 E SANDUSKY AVE
-----------------------------------------------------
City | BELLEFONTAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43311-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-592-8656
-----------------------------------------------------
Fax | 937-592-7705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIRMAN
-----------------------------------------------------
Name | TERI STEVENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-592-8656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------