Provider Demographics
| NPI: | 1457467227 |
|---|---|
| Name: | SOMC MEDICAL CARE FOUNDATION, INC. |
| Entity Type: | Organization |
| Organization Name: | SOMC MEDICAL CARE FOUNDATION, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATIVE DIRECTOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | REBECCA |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | FITE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CMPE |
| Authorized Official - Phone: | 740-356-8008 |
| Mailing Address - Street 1: | 1735 27TH ST |
| Mailing Address - Street 2: | WALLER BUILDING, SUITE B06 |
| Mailing Address - City: | PORTSMOUTH |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45662-2677 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 740-356-8008 |
| Mailing Address - Fax: | 740-356-1256 |
| Practice Address - Street 1: | 1805 27TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | PORTSMOUTH |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45662-2640 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 740-356-8681 |
| Practice Address - Fax: | 740-356-1256 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-22 |
| Last Update Date: | 2024-01-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 0916512 | Medicaid | |
| KY | 65921835 | Medicaid | |
| KY | 5588 | Medicare PIN | |
| KY | 65921835 | Medicaid | |
| OH | SO9346704 | Medicare PIN | |
| OH | SO9295285 | Medicare UPIN | |
| OH | SO9346703 | Medicare PIN | |
| OH | SO9295281 | Medicare PIN | |
| OH | SO9259144 | Medicare PIN | |
| OH | 0916512 | Medicaid | |
| OH | SO9259149 | Medicare PIN | |
| OH | SO9346705 | Medicare PIN | |
| OH | SO9259145 | Medicare PIN | |
| OH | SO9259143 | Medicare PIN | |
| OH | SO9259141 | Medicare PIN |
