Organization
COUNTRYSIDE ACUTE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK MARPLE FNP, RN, PARAMEDIC (OWNER)
(937) 605-9294
Entity
Organization
Contact information
Practice address
MAIN ST, SOUTH VIENNA, OH 45369
(937) 000-0000
Mailing address
931 WILSON RD, SOUTH VIENNA, OH 45369-9747
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
05/10/2023
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