Provider Demographics
NPI:1952639858
Name:HOMEOPATHIC OSTEOPATHIC FAMILY PRACTICE
Entity Type:Organization
Organization Name:HOMEOPATHIC OSTEOPATHIC FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:CROTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-767-2733
Mailing Address - Street 1:100 CORRY ST
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1809
Mailing Address - Country:US
Mailing Address - Phone:937-767-2733
Mailing Address - Fax:937-767-2736
Practice Address - Street 1:100 CORRY ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1809
Practice Address - Country:US
Practice Address - Phone:937-767-2733
Practice Address - Fax:937-767-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care