Provider Demographics
NPI:1679779821
Name:INDIAN CREEK FAMILY HEALTH ROSS LLC
Entity Type:Organization
Organization Name:INDIAN CREEK FAMILY HEALTH ROSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-523-5080
Mailing Address - Street 1:10 N LOCUST ST
Mailing Address - Street 2:P O BOX 700
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1192
Mailing Address - Country:US
Mailing Address - Phone:513-523-2340
Mailing Address - Fax:513-523-5080
Practice Address - Street 1:2449 ROSS MILLVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-523-2340
Practice Address - Fax:513-523-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty