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General NPI Number Information
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NPI Number | 1669453189
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 610 NORTHRIDGE RD
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City | CIRCLEVILLE
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State | OH
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Zip | 43113
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Country | US
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Telephone | 740-474-3159
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Fax | 740-474-2110
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Provider Business Mailing Address
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Address Line | 610 NORTHRIDGE RD PO BOX 578
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City | CIRCLEVILLE
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State | OH
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Zip | 43113
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Country | US
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Telephone | 740-474-3159
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Fax | 740-474-2110
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBORAH LEA LEWIS
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Credential |
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Telephone | 740-474-3159
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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 | 35071002J
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35053974M
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 350463858
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35042158B
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License Number State | OH
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