Provider Demographics
NPI:1891737698
Name:SPRINGFIELD CENTER FOR FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD CENTER FOR FAMILY MEDICINE, INC.
Other - Org Name:MARK S ROBERTO MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-399-7777
Mailing Address - Street 1:3250 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9285
Mailing Address - Country:US
Mailing Address - Phone:937-399-7777
Mailing Address - Fax:937-399-6794
Practice Address - Street 1:3250 MIDDLE URBANA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9285
Practice Address - Country:US
Practice Address - Phone:937-399-7777
Practice Address - Fax:937-399-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201494OtherBLACK LUNG
OHCA5632OtherRAILROAD MEDICARE
OH2573415Medicaid
OH000000013160OtherANTHEM BCBS
OH0637341OtherAETNA
OH201494OtherBLACK LUNG