Provider Demographics
NPI:1124138615
Name:INDIAN CREEK FAMILY HEA
Entity type:Organization
Organization Name:INDIAN CREEK FAMILY HEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-235-2340
Mailing Address - Street 1:10 N LOCUST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1192
Mailing Address - Country:US
Mailing Address - Phone:513-523-2340
Mailing Address - Fax:513-523-5080
Practice Address - Street 1:10 N LOCUST ST
Practice Address - Street 2:SUITE D
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1192
Practice Address - Country:US
Practice Address - Phone:513-523-2340
Practice Address - Fax:513-523-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200220Medicare PIN
OH9316381Medicare PIN