Provider Demographics
NPI:1114654753
Name:MODERN MEDICINE, LLC
Entity Type:Organization
Organization Name:MODERN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:513-268-5655
Mailing Address - Street 1:5353 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8089
Mailing Address - Country:US
Mailing Address - Phone:513-268-5655
Mailing Address - Fax:513-987-9588
Practice Address - Street 1:5353 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8089
Practice Address - Country:US
Practice Address - Phone:513-268-5655
Practice Address - Fax:513-987-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No305S00000XManaged Care OrganizationsPoint of Service