Provider Demographics
NPI:1093840993
Name:FAMILY PRACTICE CENTER OF WADSWORTH INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF WADSWORTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-334-6229
Mailing Address - Street 1:251 LEATHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9236
Mailing Address - Country:US
Mailing Address - Phone:330-334-6229
Mailing Address - Fax:330-334-6110
Practice Address - Street 1:251 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-334-6229
Practice Address - Fax:330-334-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050673F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9265331OtherMEDICARE GROUP PTAN-FPCW
OH0102518OtherJOSHUA D. RAINES, DO MEDICAID ID
OHA16460OtherMATTHEW P. FINNERAN, MD MEDICARE UPIN
OH3107668Medicaid
OHH206900OtherJOSHUA D. RAINES, DO MEDICARE PTAN
OHH437901OtherBRINKMAN A. MURRAY, DO MEDICARE PTAN
OH0557848Medicaid
OH2164250OtherMEDICAID FPCW
OH3000344Medicaid
H403930OtherCYNTHIA MAZEY, CNP PTAN
OHH437901OtherBRINKMAN A. MURRAY, DO MEDICARE PTAN
OHA16460OtherMATTHEW P. FINNERAN, MD MEDICARE UPIN