Provider Demographics
NPI:1114970001
Name:FAMILY PRACTICE ASSOCIATES, INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OVERCASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-832-3188
Mailing Address - Street 1:2300 WALES AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-832-3188
Mailing Address - Fax:330-832-9936
Practice Address - Street 1:2300 WALES AVENUE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-832-3188
Practice Address - Fax:330-832-9936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398654Medicaid
OH0398654Medicaid