Southland Family Medicine Associates Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35 03 2392 S Issued in OH

Legal business name

SOUTHLAND FAMILY MEDICINE ASSOCIATES INC

Practice address

03920 Southland Rd
New Bremen, OH 45869

Phone

(419) 629-2772

Fax

(419) 629-3613

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Victor J Stegall, MD

Title

Director

Phone

(419) 629-2772

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1801976311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "03920 SOUTHLAND RD PO BOX 127",
            "city": "NEW BREMEN",
            "state": "OH",
            "postal_code": "45869",
            "telephone_number": "419-629-2772",
            "fax_number": "419-629-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "03920 SOUTHLAND RD",
            "city": "NEW BREMEN",
            "state": "OH",
            "postal_code": "45869",
            "telephone_number": "419-629-2772",
            "fax_number": "419-629-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND FAMILY MEDICINE ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "STEGALL",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-629-2772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35 03 2392 S",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35 04 8500 L",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35 02 4908 B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0995811",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in New Bremen, OH
• Providers in New Bremen, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; 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.