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810 Orchard Ln Suite 102 Beavercreek Township OH 45434-7229 | |
(937) 320-4428 | |
(937) 320-4408 |
Full Name | |
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Speciality | Family Medicine |
Location | 810 Orchard Ln, Beavercreek Township, Ohio |
Authorized Official Name and Position | Suzanne Therese Croteau (PRESIDENT) |
Authorized Official Contact | 9373204428 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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810 Orchard Ln Suite 102 Beavercreek Township OH 45434-7229 Ph: (937) 320-4428 | 810 Orchard Ln Suite 102 Beavercreek Township OH 45434-7229 Ph: (937) 320-4428 |
NPI Number | 1336336544 |
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Provider Enumeration Date | 10/02/2007 |
Last Update Date | 06/13/2014 |
Medicare PECOS PAC ID | 2668568643 |
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Medicare Enrollment ID | O20071023000024 |
Identifier | Type | State | Issuer |
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1336336544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Suzanne T Croteau |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306979505 PECOS PAC ID: 7012003098 Enrollment ID: I20071023000033 |