1598969214 NPI number — OHIO FAMILY PRACTICE CENTERS, INC

Table of content: (NPI 1598969214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598969214 NPI number — OHIO FAMILY PRACTICE CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO FAMILY PRACTICE CENTERS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598969214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 SMITH ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-3766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-836-8471
Provider Business Mailing Address Fax Number:
330-665-5840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3009 SMITH ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-3766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-836-8471
Provider Business Practice Location Address Fax Number:
330-665-5840
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WICZEN
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
330-836-8471

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55000051CTP . This is a "STATE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1598969214 . This is a "GROUP NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2283176 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35092267C . This is a "STATE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 35070564S . This is a "STATE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 35077042D . This is a "STATE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0276133 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2369217 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2973420 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164694758 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1548238454 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1770551509 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1891763058 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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