Provider Demographics
NPI:1144785098
Name:FC OHIO, LLC
Entity Type:Organization
Organization Name:FC OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-600-3478
Mailing Address - Street 1:PO BOX 40166
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-0166
Mailing Address - Country:US
Mailing Address - Phone:615-600-3447
Mailing Address - Fax:877-471-4152
Practice Address - Street 1:2006 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9069
Practice Address - Country:US
Practice Address - Phone:937-419-4944
Practice Address - Fax:937-419-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty