Organization
MOUND FAMILY PRACTICE ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BRENT ASHCRAFT M.D. (PRESIDENT)
(937) 866-0741
Entity
Organization
Contact information
Practice address
1012 E CENTRAL AVE, MIAMISBURG, OH 45342-2556
(937) 866-0741
(937) 866-8861
Mailing address
20 N RIDGE, SPRINGBORO, OH 45066-9283
(937) 748-2699
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003291
ANTHEM
OH
05
—
0959342
—
OH
01
—
CF1385
RR MEDICARE
OH
Enumeration date
10/03/2006
Last updated
05/02/2013
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