Provider Demographics
NPI:1013034206
Name:PEDIATRIC AND FAMILY MEDICINE HEALTH CARE INC.
Entity Type:Organization
Organization Name:PEDIATRIC AND FAMILY MEDICINE HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-837-4467
Mailing Address - Street 1:2400 WALES AVE NW
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-0804
Mailing Address - Country:US
Mailing Address - Phone:330-837-4467
Mailing Address - Fax:330-837-4688
Practice Address - Street 1:2400 WALES AVE NW
Practice Address - Street 2:SUITE C & D
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-0804
Practice Address - Country:US
Practice Address - Phone:330-837-4467
Practice Address - Fax:330-837-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-100320261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673192Medicaid