| South Community Primary Care Inc | |
|
3095 Kettering Blvd Moraine OH 45439 | |
| (937) 531-1974 | |
| (937) 534-1579 |
| Full Name | South Community Primary Care Inc |
|---|---|
| Speciality | General Practice |
| Location | 3095 Kettering Blvd, Moraine, Ohio |
| Authorized Official Name and Position | Carol M Smerz (CEO) |
| Authorized Official Contact | 9372938300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Community Primary Care Inc 3095 Kettering Blvd Moraine OH 45439 Ph: (937) 531-1974 | South Community Primary Care Inc 3095 Kettering Blvd Moraine OH 45439 Ph: (937) 531-1974 |
| NPI Number | 1326334624 |
|---|---|
| Provider Enumeration Date | 06/24/2011 |
| Last Update Date | 04/10/2018 |
| Medicare PECOS PAC ID | 9234374851 |
|---|---|
| Medicare Enrollment ID | O20130401000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326334624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Meredith Ellen Staas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194269936 PECOS PAC ID: 9739460999 Enrollment ID: I20161229001673 |
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