SOUTHLAND FAMILY MEDICINE ASSOCIATES INC , NPI 1801976311 — NEW BREMEN (OH)

NPI 1801976311

13+ Years Experience Organization

SOUTHLAND FAMILY MEDICINE ASSOCIATES INC

10/17/2006
PROVIDER ENUMERATION DATE
01/27/2010
LAST UPDATE DATE
1801976311
NPI NUMBER

About SOUTHLAND FAMILY MEDICINE ASSOCIATES INC

SOUTHLAND FAMILY MEDICINE ASSOCIATES INC is a provider established in NEW BREMEN, OH. The NPI number of SOUTHLAND FAMILY MEDICINE ASSOCIATES INC is 1801976311 and was assigned on 10/17/2006. The practitioners primary taxonomy code is: 207Q00000X with license number: 35 04 8500 L OH .

Mailing address

  • City: NEW BREMEN
  • State: OH
  • Postal code: 45869
  • Phone: 4196292772
  • Fax: 4196293613
  • Address: 03920 SOUTHLAND RD PO BOX 127

Primary Practice Address

  • Region : NEW BREMEN, OH
  • NPI : 1801976311
  • Phone : 4196292772
  • Fax : 4196293613
  • Postalcode : 45869
  • Address : 03920 SOUTHLAND RD

Additional identifiers

  • Identifier: 995811
  • Code / Type : 5 - MEDICAID
  • Identifier state : OH

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Family Medicine

  • Taxonomy code: 207Q00000X
  • License number: 35 04 8500 L
  • License state: OH

The taxonomy is not the primary taxonomy.

Taxonomy group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP.

Taxonomy description: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Healthcare provider taxonomy #2 - Family Medicine

  • Taxonomy code: 207Q00000X
  • License number: 35 02 4908 B
  • License state: OH

The taxonomy is not the primary taxonomy.

Taxonomy description: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Contacts:

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  • SOUTHLAND FAMILY MEDICINE ASSOCIATES INC
  • Address : 03920 SOUTHLAND RD
  • Region : NEW BREMEN, OH
  • NPI : 1801976311
  • Phone : 4196292772
  • Fax : 4196293613
  • Postalcode : 45869

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 4196292772
  • Title or position : DIRECTOR
  • Credentials : MD

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address03920 SOUTHLAND RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameNEW BREMEN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameOH
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code45869
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number4196292772
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4196293613
The fax number associated with the location address of the provider being identified.
NPI1801976311
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1207Q00000X
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Provider Enumeration Date10/17/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated01/27/2010
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Organization SubpartN
The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don"t know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provider Organization Name (Legal Business Name)SOUTHLAND FAMILY MEDICINE ASSOCIATES INC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address03920 SOUTHLAND RD PO BOX 127
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameNEW BREMEN
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameOH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code45869
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number4196292772
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number4196293613
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameSTEGALL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameVICTOR
The first name of the authorized official
Authorized Official Middle NameJ
The middle name of the authorized official
Authorized Official Title or PositionDIRECTOR
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextMD
Authorized Official Credential Text
Authorized Official Telephone Number4196292772
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1207Q00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Provider License Number 135 04 8500 L
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1OH
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2207Q00000X
Healthcare Provider Taxonomy 2Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Provider License Number 235 02 4908 B
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2OH
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1995811
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1OH
Other Provider Identifier State #1
X

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