Provider Demographics
NPI:1568781003
Name:RENE AMBURN MD INC
Entity Type:Organization
Organization Name:RENE AMBURN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:AMBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-483-2273
Mailing Address - Street 1:250 CASTALIA ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811
Mailing Address - Country:US
Mailing Address - Phone:419-483-2273
Mailing Address - Fax:419-483-8914
Practice Address - Street 1:250 CASTALIA ST
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811
Practice Address - Country:US
Practice Address - Phone:419-483-2273
Practice Address - Fax:419-483-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty