Provider Demographics
NPI:1033270137
Name:MY FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:MY FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-899-7677
Mailing Address - Street 1:29257 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5224
Mailing Address - Country:US
Mailing Address - Phone:440-899-7677
Mailing Address - Fax:440-899-7667
Practice Address - Street 1:29257 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5224
Practice Address - Country:US
Practice Address - Phone:440-899-7677
Practice Address - Fax:440-899-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4084671Medicare PIN
OHMY9320841Medicare ID - Type Unspecified