Provider Demographics
NPI:1003092495
Name:TINA NELSON MD & ASSOCIATES LLC
Entity Type:Organization
Organization Name:TINA NELSON MD & ASSOCIATES LLC
Other - Org Name:FAMILY 1ST HEALTHCARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-345-8410
Mailing Address - Street 1:3477 COMMERCE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7126
Mailing Address - Country:US
Mailing Address - Phone:330-345-8410
Mailing Address - Fax:330-345-8458
Practice Address - Street 1:3477 COMMERCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7126
Practice Address - Country:US
Practice Address - Phone:330-345-8410
Practice Address - Fax:330-345-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247732Medicaid
OHH36250Medicare UPIN