Provider Demographics
NPI:1710314901
Name:BEAVERCREEK FAMILY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BEAVERCREEK FAMILY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITECAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-477-2460
Mailing Address - Street 1:2365 LAKEVIEW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4600
Mailing Address - Country:US
Mailing Address - Phone:937-477-3460
Mailing Address - Fax:
Practice Address - Street 1:2365 LAKEVIEW DR
Practice Address - Street 2:SUITE C
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4600
Practice Address - Country:US
Practice Address - Phone:937-477-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH230060Medicare PIN