Providence Medical Group

NPI #1811304595 in Moraine, Ohio

Provider Information

NPI Number: 1811304595
Entity Type: Organization
Organization Name: Providence Medical Group
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDENCE PODIATRY
Primary Specialty: Podiatrist
Enumeration Date: Jul 15, 2014
Last Updated: Oct 28, 2014

Practice Location

Address: 2912 SPRINGBORO RD
Address 2: SUITE 201
City: Moraine
State: Ohio
ZIP Code: 45439-1674
Phone: (937) 297-8999

Authorized Official

Name: SUSAN BECKER, COO
Title: CHIEF OPERATING OFFICER
Phone: (937) 297-8999

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist	213E00000X	Primary

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