Provider Demographics
NPI:1215136460
Name:RICHARD SIMMAN MD LLC
Entity type:Organization
Organization Name:RICHARD SIMMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-384-0780
Mailing Address - Street 1:PO BOX 181257
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45018-1257
Mailing Address - Country:US
Mailing Address - Phone:937-384-0780
Mailing Address - Fax:937-384-0781
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:STE 104
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3674
Practice Address - Country:US
Practice Address - Phone:937-384-0780
Practice Address - Fax:937-384-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086S0122X
OH1706540261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165676Medicaid
OH9370341Medicare PIN
OH4127393Medicare PIN