Provider Demographics
NPI:1861571176
Name:SOUTH CENTRAL FAMILY PHYSICIANS INC
Entity type:Organization
Organization Name:SOUTH CENTRAL FAMILY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-644-0022
Mailing Address - Street 1:3529 FORTUNA DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5282
Mailing Address - Country:US
Mailing Address - Phone:330-644-0022
Mailing Address - Fax:330-644-0328
Practice Address - Street 1:3529 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5282
Practice Address - Country:US
Practice Address - Phone:330-644-0022
Practice Address - Fax:330-644-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0909977Medicaid
OH0909977Medicaid