MEDICARE: SPRINGFIELD CENTER FOR FAMILY MEDICINE, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA5632	OTHER	OH	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201494	OTHER	OH	BLACK LUNG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000013160	OTHER	OH	ANTHEM BCBS
5	0637341	OTHER	OH	AETNA

NPI Number	:	1891737698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFIELD CENTER FOR FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	3250 MIDDLE URBANA RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45502-9285
Country	:	US
Telephone Number	:	937-399-7777
Fax Number	:	937-399-6794

Provider Business Practice Location Address
First Line	:	3250 MIDDLE URBANA RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45502-9285
Country	:	US
Telephone Number	:	937-399-7777
Fax Number	:	937-399-6794

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER J MUIR
Credential	:	M.D.
Telephone Number	:	937-399-7777

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/23/2014

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

3250 MIDDLE URBANA RD
SPRINGFIELD, OH
45502-9285