Organization
INTERNAL MEDICINE ASSOCIATES OF CLINTON COUNTY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE EDMUND STALEY MD (PRESIDENT)
(937) 382-5030
Entity
Organization
Contact information
Practice address
891 W LOCUST ST, WILMINGTON, OH 45177-2118
(937) 382-5030
(937) 655-8390
Mailing address
891 W LOCUST ST, WILMINGTON, OH 45177-2118
(937) 382-5030
(937) 655-8390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0385373
—
OH
01
—
IN9287061
MEDICARE GROUP
OH
Enumeration date
08/24/2005
Last updated
07/21/2022
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