Provider Demographics
NPI:1609081314
Name:STUDEBAKER FAMILY PRACTICE INC.
Entity Type:Organization
Organization Name:STUDEBAKER FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LETNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-833-4103
Mailing Address - Street 1:98 MOSIER PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1750
Mailing Address - Country:US
Mailing Address - Phone:937-833-4103
Mailing Address - Fax:937-833-3147
Practice Address - Street 1:98 MOSIER PKWY
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1750
Practice Address - Country:US
Practice Address - Phone:937-833-4103
Practice Address - Fax:937-833-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000233928OtherANTHEM BC/BS
OH2372696Medicaid