Provider Demographics
NPI:1477441681
Name:WORTHAM & FLORENCE ENTERPRISES
Entity type:Organization
Organization Name:WORTHAM & FLORENCE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WORTHAM-FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-321-0002
Mailing Address - Street 1:113 CLARETT CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3545
Mailing Address - Country:US
Mailing Address - Phone:937-321-0002
Mailing Address - Fax:
Practice Address - Street 1:6545 MARKET AVE N STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2430
Practice Address - Country:US
Practice Address - Phone:937-321-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty