PROVIDENCE MEDICAL GROUP (NPI# 1811304595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811304595 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE MEDICAL GROUP |
| Practice Address |
2912 Springboro Rd Suite 201 Moraine OH 45439-1674 |
| Practice Telephone | 9372978999 |
| Practice Fax Number | 9372974852 |
| Mailing Telephone | 9372978999 |
| Mailing Fax Number | 9372974852 |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-10-28 |
| Authorized Official Name | SUSAN BECKER (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 9372978999 |
| Authorized Official Credential | COO |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PODIATRY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 36.003657 | OH | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | INDIVIDUAL NPI | 1285952937 | 01 |
| OH | 0083030 | 05 | |
| OH | 2380294 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194196832 | Providence Medical Group | General Acute Care Hospital | 1806 Wadsworth Avenue, Bakersfield, CA 93311 | 2015-10-07 |
| 1972533149 | Providence Medical Group | Obstetrics & Gynecology | 2912 Springboro Rd W, Suite 201, Dayton, OH 45439-1674 | 2006-07-04 |
| 1952947939 | Providence Medical Group | Orthopaedic Surgery | 8919 Parallel Pkwy Ste 555, Kansas City, KS 66112-3628 | 2019-11-25 |
| 1760658371 | Providence Medical Group | Clinical Medical Laboratory | 2912 Springboro W, Suite 203, Moraine, OH 45439-1674 | 2008-05-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROVIDENCE MEDICAL GROUP | 105 W 8th Ave Ste 660e, Spokane, WA 99204-2302 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP | 1801 Lind Ave Sw, Renton, WA 98057 |
| Ohio Business Entities | PROVIDENCE MEDICAL GROUP - THE HEIGHTS | 2912 Springboro West, Suite 201, Dayton, OH 45439 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP ALASKA | 1801 Lind Ave Sw, Renton, WA 98057 |
| Ohio Business Entities | PROVIDENCE MEDICAL GROUP LABORATORY | 2912 Springboro West, Dayton, OH 45439 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP MONTANA | 1801 Lind Ave Sw, Renton, WA 98057 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP NORTHWEST WASHINGTON | 1801 Lind Ave Sw, Renton, WA 98057 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP SOUTHEAST WASHINGTON | 1801 Lind Ave Sw, Renton, WA 98057 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE MEDICAL GROUP SOUTHWEST WASHINGTON | 1801 Lind Ave Sw, Renton, WA 98057 |
| Indiana Business Entities | PROVIDENCE MEDICAL GROUP, LLC | 2723 South 7th Street, Suite A, Terre Haute, IN 47802 |
| Street Address |
2912 SPRINGBORO RD SUITE 201 |
| City | MORAINE |
| State | OH |
| Zip Code | 45439-1674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982702213 | Paula A Kimpton | Nurse Practitioner | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2006-09-20 |
| 1659726768 | Providence Medical Group, Inc. | Radiology | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2016-04-26 |
| 1285071399 | Corey A Davis | Nurse Practitioner | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2013-05-30 |
| 1689916744 | Tina M Garland | Nurse Practitioner | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2013-03-26 |
| 1912261744 | Providence Health Partners | Clinic/Center | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2012-06-26 |
| 1972886943 | Jacqueline June Davis | Nurse Practitioner | 2912 Springboro Rd, Moraine, OH 45439-1674 | 2011-09-26 |
| 1487956264 | Danielle Renee Little | Nurse Practitioner | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2010-11-29 |
| 1598092710 | Lisa A Rhodes | Nurse Practitioner | 2912 Springboro Rd, Suite 201, Moraine, OH 45439-1674 | 2009-11-09 |
| 1699831693 | Terren Burgess Koles | General Practice | 2912 Springboro Rd, Suite, Moraine, OH 45439-1674 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104455260 | Joseph Michael Meacham | Counselor | 3059 Kettering Blvd., Moraine, OH 45439 | 2020-04-02 |
| 1932673597 | Sabrina M Nichols | Behavior Technician | 5290 Cobblegate Drive, Moraine, OH 45439 | 2019-01-17 |
| 1013406040 | Chevelle Antionette Bennett | Licensed Practical Nurse | 4964 Springboco Pk, Mocaine, OH 45439 | 2018-05-04 |
| 1205332418 | Vincent A Mcbride | Case Manager/Care Coordinator | 3350 South Kettering Blvd, Moraine, OH 45439 | 2018-04-05 |
| 1124532635 | Rodescu Macklin | Counselor | 200 Daruma Parkway, Moraine, OH 45439 | 2017-11-20 |
| 1194248872 | Blu Diamond Home Care LLC | Home Health | 3481 Office Park Drive, Suite 12d, Dayton, OH 45439 | 2017-07-25 |
| 1003342692 | Chadonn Cummings | Social Worker | 3905 Kettering Blvd, Moriane, OH 45439 | 2017-05-03 |
| 1962959098 | Jessica Woody | Counselor | 3011kettering Blvd, Suite 311, Moraine, OH 45439 | 2016-09-07 |
| 1427409309 | Aida E Scanlon | Physician Assistant | 3445 S Dixie Dr, Moraine, OH 45439 | 2016-06-22 |
| 1881048908 | Judith Crum | Counselor | 4983 Joyce Dr., Dayton, OH 45439 | 2016-04-14 |
| Find all providers in zip 45439 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518950 | Mobile Foot Care Specialists, L.L.C. | Podiatrist | 38752 Renwood Ave, Avon, OH 44011-5229 | 2020-11-06 |
| 1275159345 | Buckeye Foot Care | Podiatrist | 5105 Som Center Rd Ste 102, Willoughby, OH 44094-4203 | 2020-06-24 |
| 1285289439 | Brent L. Rubin & Associates Inc | Podiatrist | 755 W South Boundary St, Perrysburg, OH 43551-5226 | 2019-08-05 |
| 1902467459 | Zaccardelli and Ritz | Podiatrist | 5556 Ridge Rd, Parma, OH 44129-2305 | 2019-06-25 |
| 1134786635 | Integrity Foot and Ankle Associates, LLC | Podiatrist | 1740 Cooper Foster Park Rd W Ste B, Lorain, OH 44053-4201 | 2019-05-21 |
| 1891351185 | Foot and Ankle Specialists of Central Ohio LLC | Podiatrist | 1 Healthy Place, Suite 202, Pataskala, OH 43062-7067 | 2019-05-13 |
| 1376109660 | Foot and Ankle Specialists of Central Ohio LLC | Podiatrist | 65 E Granville St, Sunbury, OH 43074-9130 | 2019-05-13 |
| 1770149296 | Foot and Ankle Specialists of Central Ohio, LLC | Podiatrist | 6002 E. Main Street, Columbus, OH 43213-3355 | 2019-05-10 |
| 1295390268 | Greenberg Foot and Ankle | Podiatrist | 1989 Miamisburg Centerville Rd Ste 200, Dayton, OH 45459-3858 | 2019-05-06 |
| 1083278287 | Kburtondpm LLC | Podiatrist | 662 Seagull Ct, Westerville, OH 43082-8534 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PROVIDENCE MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.