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General NPI Number Information
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NPI Number | 1710213483
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Entity Type | Organization
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Legal Business Name | SPRINGBORO MEDICAL ARTS, INC
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 84 REMICK BLVD
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City | SPRINGBORO
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State | OH
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Zip | 45066-9168
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Country | US
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Telephone | 937-619-0444
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Fax | 937-619-0445
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Provider Business Mailing Address
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Address Line | 84 REMICK BLVD
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City | SPRINGBORO
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State | OH
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Zip | 45066-9168
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Country | US
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Telephone | 937-619-0444
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Fax | 937-619-0445
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DESIDERIO PINA
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Credential | M.D.
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Telephone | 937-619-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 35083573
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License Number State | OH
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