Provider Demographics
NPI:1831295674
Name:BLUFFTON FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:BLUFFTON FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-369-4804
Mailing Address - Street 1:582 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1069
Mailing Address - Country:US
Mailing Address - Phone:419-369-4804
Mailing Address - Fax:419-369-4805
Practice Address - Street 1:582 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1069
Practice Address - Country:US
Practice Address - Phone:419-369-4804
Practice Address - Fax:419-369-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1508818568Other1508818568
OHDC6643OtherRAILROAD MEDICARE
OH1831295674OtherGROUP NPI