Provider Demographics
NPI:1407834955
Name:PROFESSIONAL PRIMARY CARE SERVICES OF SOUTHERN OHIO
Entity Type:Organization
Organization Name:PROFESSIONAL PRIMARY CARE SERVICES OF SOUTHERN OHIO
Other - Org Name:HILLSBORO URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-383-1040
Mailing Address - Street 1:PO BOX 951216
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0011
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:
Practice Address - Street 1:160 ROBERTS LN
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7608
Practice Address - Country:US
Practice Address - Phone:937-383-1040
Practice Address - Fax:937-383-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty