Organization
BROADWAY FAMILY MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE EBEL DO (PRESIDENT)
(513) 932-1936
Entity
Organization
Contact information
Practice address
1470 N BROADWAY ST, SUITE100, LEBANON, OH 45036-1744
(513) 932-1936
(513) 932-3105
Mailing address
PO BOX 4723, BELFAST, ME 04915-4723
(513) 932-1936
(513) 932-3105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2378538
—
OH
01
—
CK5993
RR MCR
OH
Enumeration date
11/18/2005
Last updated
09/20/2018
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