| Maple Leaf Family And Sports Medicine, Llc | |
|
2211 Timber Trail Bellefontaine OH 43311 | |
| (937) 592-3808 | |
| (937) 593-8404 |
| Full Name | Maple Leaf Family And Sports Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2211 Timber Trail, Bellefontaine, Ohio |
| Authorized Official Name and Position | Boyd C Hoddinott (PARTNER) |
| Authorized Official Contact | 9375923808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Leaf Family And Sports Medicine, Llc 2211 Timber Trail Bellefontaine OH 43311 Ph: (937) 592-3808 | Maple Leaf Family And Sports Medicine, Llc 2211 Timber Trail Bellefontaine OH 43311 Ph: (937) 592-3808 |
| NPI Number | 1447328067 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7416844592 |
|---|---|
| Medicare Enrollment ID | O20040303000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447328067 | NPI | - | NPPES |
| 2225827 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kristen T Braig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265422950 PECOS PAC ID: 4789571886 Enrollment ID: I20040303000317 |
| Provider Name | John C O'connor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184600512 PECOS PAC ID: 6204723398 Enrollment ID: I20040324000838 |
| Provider Name | Kathleen J Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194971911 PECOS PAC ID: 1254595648 Enrollment ID: I20120615000045 |
| Provider Name | Carolyn Ricketts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316613276 PECOS PAC ID: 4981096005 Enrollment ID: I20220124001434 |
Mad River Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2231 Timber Trl, Bellefontaine, OH 43311 Phone: 937-599-3115 Fax: 937-592-5285 | |
Logan Family Medical Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2210 Timber Trl, Bellefontaine, OH 43311 Phone: 937-593-3151 | |
Hickory Medical Direct Primary Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 208 W Columbus Ave, Bellefontaine, OH 43311 Phone: 937-404-2488 Fax: 937-404-2428 | |
Mary Rutan Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 Dowell Ave, Bellefontaine, OH 43311 Phone: 937-593-5437 Fax: 937-593-0110 | |
Bellefontaine Community Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 212 E Columbus Ave Ste 1, Bellefontaine, OH 43311 Phone: 937-599-1411 Fax: 937-599-4128 | |
Mary Rutan Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2231 Timber Trl, Bellefontaine, OH 43311 Phone: 937-599-3115 |