Basic Information
| Provider Information | |||||||||
| NPI: | 1245278902 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE DOCTORS OFFICE CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | YORK TOWNSHIP FAMILY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71 | ||||||||
| Address2: | |||||||||
| City: | NELSONVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457640071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407533345 | ||||||||
| FaxNumber: | 7407534890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 MOUNT SAINT MARYS DR | ||||||||
| Address2: | |||||||||
| City: | NELSONVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457641280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407533345 | ||||||||
| FaxNumber: | 7407534890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALLISON | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | C.F.O. | ||||||||
| AuthorizedOfficialTelephone: | 7407531931 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0868664 | 05 | OH | MEDICAID |