Provider Demographics
NPI:1770919599
Name:INDIAN CREEK FAMILY HEALTH OXFORD LLC
Entity type:Organization
Organization Name:INDIAN CREEK FAMILY HEALTH OXFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-523-2340
Mailing Address - Street 1:10 N LOCUST ST
Mailing Address - Street 2:SUITE D
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 1:10 N LOCUST ST
Practice Address - Street 2:STE. D
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1192
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:2013-09-25
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090660207Q00000X
OH50000716363A00000X
OHNP10024363LF0000X
OHOH35076875H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1164557575OtherNPI
OH1912017583OtherNPI
OH1730313990OtherNPI
OH1912166729OtherNPI