Provider Demographics
NPI:1164841912
Name:YELLOW SPRINGS PRIMARY CARE, INC
Entity Type:Organization
Organization Name:YELLOW SPRINGS PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-771-6496
Mailing Address - Street 1:888 DAYTON ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1778
Mailing Address - Country:US
Mailing Address - Phone:937-767-1088
Mailing Address - Fax:937-767-1022
Practice Address - Street 1:888 DAYTON ST UNIT 106
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1778
Practice Address - Country:US
Practice Address - Phone:937-767-1088
Practice Address - Fax:937-767-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120593261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096525Medicaid