MEDICARE: ON-SITE PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner
2	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1558634188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-SITE PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	1251 E DOROTHY LN
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-2106
Country	:	US
Telephone Number	:	937-395-3023
Fax Number	:	937-853-0552

Provider Business Practice Location Address
First Line	:	1251 E DOROTHY LN
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-2106
Country	:	US
Telephone Number	:	937-395-3023
Fax Number	:	937-853-0552

Authorized Official
Title or Position	:	CFO
Name	:	ALFRED E LEFELD
Credential	:
Telephone Number	:	937-395-3023

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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Directions to “ON-SITE PHYSICIANS LLC ” Practice Location

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