Provider Demographics
NPI:1053600775
Name:FIVE RIVERS HEALTH CENTERS
Entity type:Organization
Organization Name:FIVE RIVERS HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MAKEBA
Authorized Official - Last Name:MCFARLANE-EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-734-6841
Mailing Address - Street 1:2261 PHILADELPHIA DR.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406
Mailing Address - Country:US
Mailing Address - Phone:937-734-6846
Mailing Address - Fax:937-276-8245
Practice Address - Street 1:2261 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-276-4141
Practice Address - Fax:937-277-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050099Medicaid
OHH126430Medicare UPIN