Provider Demographics
NPI:1831274901
Name:COSTIN FAMILY PRACTICE, INC
Entity type:Organization
Organization Name:COSTIN FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-599-3085
Mailing Address - Street 1:921 E SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2855
Mailing Address - Country:US
Mailing Address - Phone:937-599-3085
Mailing Address - Fax:
Practice Address - Street 1:921 E SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2855
Practice Address - Country:US
Practice Address - Phone:937-599-3085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0750665Medicaid
OH0750665Medicaid