Provider Demographics
NPI:1073751673
Name:SOUTHERN OHIO NP CARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN OHIO NP CARE, LLC
Other - Org Name:URGENT CARE AND INTERNAL MEDICINE OF WEST JEFFERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:937-790-0969
Mailing Address - Street 1:40 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8125
Mailing Address - Country:US
Mailing Address - Phone:937-790-0969
Mailing Address - Fax:937-748-8379
Practice Address - Street 1:95 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1178
Practice Address - Country:US
Practice Address - Phone:614-879-7100
Practice Address - Fax:614-879-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1073751673OtherANTHEM
OH29654672700OtherBUREAU OF WORMAN'S COMPENSATION
OH9110306OtherAETNA
OH2926454Medicaid
OH9110306OtherAETNA
OH29654672700OtherBUREAU OF WORMAN'S COMPENSATION