| Main Street Family Practice Inc | |
|
9000 North Main Street Suite 403 Dayton OH 45415-1180 | |
| (937) 836-5171 | |
| (937) 832-0728 |
| Full Name | Main Street Family Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 9000 North Main Street, Dayton, Ohio |
| Authorized Official Name and Position | Martin K Fujimura (PRESIDENT) |
| Authorized Official Contact | 9378365171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Practice Inc 9000 North Main Street Suite 403 Dayton OH 45415-1180 Ph: (937) 836-5171 | Main Street Family Practice Inc 9000 North Main Street Suite 403 Dayton OH 45415-1180 Ph: (937) 836-5171 |
| NPI Number | 1093864035 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6002889706 |
|---|---|
| Medicare Enrollment ID | O20040819000258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093864035 | NPI | - | NPPES |
| 00000013156 | Other | ANTHEM BCBS | |
| 0668433 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Ohio) | Primary |
| Provider Name | Aco Jovanov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639179856 PECOS PAC ID: 4486627189 Enrollment ID: I20040819000238 |
| Provider Name | Martin Fujimura |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548267461 PECOS PAC ID: 2466425160 Enrollment ID: I20100323000462 |
| Provider Name | Kathleen Wittberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144220641 PECOS PAC ID: 4688709173 Enrollment ID: I20100323000564 |
| Provider Name | Angela Marie Keeton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770099889 PECOS PAC ID: 2365704129 Enrollment ID: I20180315001398 |
Kenvic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Elizabeth Pl, Sixth Floor, Dayton, OH 45408 Phone: 937-222-5963 | |
Woodcroft Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4235 Indian Ripple Rd, Suite 210, Dayton, OH 45440 Phone: 937-427-9202 Fax: 937-427-9671 | |
Digestive Endoscopy Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4340 Clyo Rd Ste 100, Dayton, OH 45459 Phone: 937-534-7330 Fax: 937-297-2208 | |
Charles Drew Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1323 W 3rd St, Dayton, OH 45402 Phone: 937-586-9733 Fax: 937-461-9698 | |
Infectious Disease Physicians Of Dayton Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9000 N Main St, Infusion Services, Dayton, OH 45415 Phone: 937-279-5803 Fax: 937-279-5873 | |
Specialty Medicine Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1989 Miamisburg Centerville Rd Ste 304, Dayton, OH 45459 Phone: 937-429-0607 | |
Glenda Lopez-blaza Md, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8710 N Dixie Dr, Dayton, OH 45414 Phone: 937-415-0501 Fax: 937-415-0520 |