Provider Demographics
NPI:1083242549
Name:OHIO PRIMARY CARE SERVICES LLC
Entity Type:Organization
Organization Name:OHIO PRIMARY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEHCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-201-6021
Mailing Address - Street 1:8645 MALLARD CIR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-6004
Mailing Address - Country:US
Mailing Address - Phone:740-201-6021
Mailing Address - Fax:740-785-4700
Practice Address - Street 1:8645 MALLARD CIR
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-6004
Practice Address - Country:US
Practice Address - Phone:740-201-6021
Practice Address - Fax:740-785-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty