Organization
PROSPECT FAMILY MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JOHN PIACENTINI MD (PRESIDENT)
(740) 494-2624
Entity
Organization
Contact information
Practice address
102 WATER STREET, PROSPECT, OH 43342
(740) 494-2624
(740) 494-9013
Mailing address
102 E WATER STREET, POST OFFICE BOX 203, PROSPECT, OH 43342-0203
(740) 494-2624
(740) 494-9013
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
35054820P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0669174
—
OH
Enumeration date
03/13/2009
Last updated
05/17/2013
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