Provider Demographics
NPI:1124215652
Name:COSTIN FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:COSTIN FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-843-2453
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:RUSSELLS POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43348-0578
Mailing Address - Country:US
Mailing Address - Phone:937-843-2453
Mailing Address - Fax:
Practice Address - Street 1:303 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:RUSSELLS POINT
Practice Address - State:OH
Practice Address - Zip Code:43348
Practice Address - Country:US
Practice Address - Phone:937-843-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09233802Medicare PIN