Provider Demographics
NPI:1275501660
Name:FAMILY PHYSICIANS OF SPRINGFIELD, INC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF SPRINGFIELD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LAMM
Authorized Official - Last Name:KNEISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-328-8850
Mailing Address - Street 1:247 S BURNETT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2639
Mailing Address - Country:US
Mailing Address - Phone:937-328-8850
Mailing Address - Fax:937-328-8860
Practice Address - Street 1:247 S BURNETT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2639
Practice Address - Country:US
Practice Address - Phone:937-328-8850
Practice Address - Fax:937-328-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374867Medicaid
OH0786065Medicaid
OH0254817Medicaid
OH2035283Medicaid
OH0534130Medicaid
OH0786065Medicaid
OH2035283Medicaid
OHG27047Medicare UPIN
OHA77778Medicare UPIN
OHA15451Medicare UPIN