| Beckett Ridge Family Medicine, Inc. | |
|
4870 Wunnenberg Way West Chester OH 45069-4863 | |
| (513) 860-4600 | |
| (513) 860-9059 |
| Full Name | Beckett Ridge Family Medicine, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4870 Wunnenberg Way, West Chester, Ohio |
| Authorized Official Name and Position | Christopher J Diatte (PRESIDENT) |
| Authorized Official Contact | 5138604600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beckett Ridge Family Medicine, Inc. 4870 Wunnenberg Way West Chester OH 45069-4863 Ph: (513) 860-4600 | Beckett Ridge Family Medicine, Inc. 4870 Wunnenberg Way West Chester OH 45069-4863 Ph: (513) 860-4600 |
| NPI Number | 1740337765 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 12/17/2007 |
| Medicare PECOS PAC ID | 6901863224 |
|---|---|
| Medicare Enrollment ID | O20041217000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740337765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35060538 (Ohio) | Primary |
| 207Q00000X | Family Medicine | 34008204 (Ohio) | Secondary |
| Provider Name | Christopher J Diatte |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437135175 PECOS PAC ID: 3072570399 Enrollment ID: I20120423000609 |
| Provider Name | Lori G Stotz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558499467 PECOS PAC ID: 9032371836 Enrollment ID: I20120424000074 |
| Provider Name | Carrie A Pohlman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689047078 PECOS PAC ID: 8022391218 Enrollment ID: I20180327000325 |
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