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General NPI Number Information
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NPI Number | 1760649750
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Entity Type | Organization
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Legal Business Name | PARK AVENUE FAMILY PRACTICE INC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 55 PARK AVE STE 250
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City | LONDON
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State | OH
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Zip | 43140-1121
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Country | US
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Telephone | 740-852-0938
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Fax |
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Provider Business Mailing Address
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Address Line | 55 PARK AVE STE 250
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City | LONDON
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State | OH
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Zip | 43140-1121
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Country | US
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Telephone | 740-852-0938
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE BINNS
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Credential | D O
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Telephone | 740-852-0938
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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 | 34009227
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License Number State | OH
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