| Northridge Family Practice Llc | |
|
610 Northridge Rd Circleville OH 43113 | |
| (740) 474-3159 | |
| (740) 474-2110 |
| Full Name | Northridge Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 610 Northridge Rd, Circleville, Ohio |
| Authorized Official Name and Position | Deborah Lea Lewis (OFFICE MANAGER) |
| Authorized Official Contact | 7404743159 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northridge Family Practice Llc 610 Northridge Rd Po Box 578 Circleville OH 43113 Ph: (740) 474-3159 | Northridge Family Practice Llc 610 Northridge Rd Circleville OH 43113 Ph: (740) 474-3159 |
| NPI Number | 1669453189 |
|---|---|
| Provider Enumeration Date | 11/10/2005 |
| Last Update Date | 12/11/2019 |
| Medicare PECOS PAC ID | 4688650435 |
|---|---|
| Medicare Enrollment ID | O20040624000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669453189 | NPI | - | NPPES |
| 2211430 | Medicaid | OH |
| Provider Name | John G Bohlen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689665242 PECOS PAC ID: 5294711040 Enrollment ID: I20101214000071 |
| Provider Name | Heather R Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558661439 PECOS PAC ID: 1153510276 Enrollment ID: I20110105000635 |
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