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General NPI Number Information
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NPI Number | 1710749114
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Entity Type | Organization
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Legal Business Name | SENECTUM MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 954 SEDGEFIELD CT
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City | MAINEVILLE
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State | OH
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Zip | 45039-7513
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Country | US
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Telephone | 513-275-6551
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Fax | 513-275-6557
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | UNIONTOWN
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State | OH
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Zip | 44685-1060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLIS ATKINSON
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Credential | NP
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Telephone | 513-275-6551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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