Provider Demographics
NPI:1639142367
Name:SPRINGFIELD HEALTHCARE CENTER INC
Entity Type:Organization
Organization Name:SPRINGFIELD HEALTHCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-328-2310
Mailing Address - Street 1:30 WARDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2500
Mailing Address - Country:US
Mailing Address - Phone:937-328-2310
Mailing Address - Fax:937-329-2303
Practice Address - Street 1:30 WARDER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2500
Practice Address - Country:US
Practice Address - Phone:937-328-2310
Practice Address - Fax:937-329-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0793333Medicaid
OH0793333Medicaid