Provider Demographics
NPI:1578016093
Name:SPRINGFIELD PRIMARY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD PRIMARY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREWSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-575-3279
Mailing Address - Street 1:448 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1008
Mailing Address - Country:US
Mailing Address - Phone:937-505-9948
Mailing Address - Fax:937-505-9951
Practice Address - Street 1:448 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1008
Practice Address - Country:US
Practice Address - Phone:937-505-9948
Practice Address - Fax:937-505-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA15504NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096026Medicaid
OH0096026Medicaid
OHH244121Medicare UPIN