NPIMap

Organization Active NPI

Fountain City Medical Clinic Inc

  • General Practice Physician
  • Bryan, OH
National Provider Identifier
1083886915
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
35033085 Issued in OH
Legal business name
FOUNTAIN CITY MEDICAL CLINIC INC
Practice address
324 W High St
Bryan, OH 43506-1614
Phone
(419) 636-2525
Fax
(419) 636-0632
NPI assigned
Apr 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pedrito A Galupo, M.D.
Title
President
Phone
(419) 636-2525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 35033085 OH Primary

Addresses

Primary practice location

324 W High St
Bryan, OH 43506-1614

Mailing address

324 W High St
Bryan, OH 43506-1614
Phone (419) 636-2525

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1083886915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061614",
            "telephone_number": "419-636-2525",
            "fax_number": "419-636-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061614",
            "telephone_number": "419-636-2525",
            "fax_number": "419-636-0632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN CITY MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "GALUPO",
        "authorized_official_first_name": "PEDRITO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-636-2525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "OH",
            "license": "35033085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.