Organization
WATERSTREET FAMILY PRACTICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY SUE HOGAN MD (PHYSICIAN)
(937) 374-6450
Entity
Organization
Contact information
Practice address
1162 N MONROE DR, XENIA, OH 45385-1620
(937) 374-6450
(937) 374-6455
Mailing address
1162 N MONROE DR, XENIA, OH 45385-1620
(937) 374-6450
(937) 374-6455
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
35071125H
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2150032
—
OH
Enumeration date
05/24/2007
Last updated
08/22/2020
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