Provider Demographics
NPI:1205862349
Name:SYLVANIA FAMILY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:SYLVANIA FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-885-0900
Mailing Address - Street 1:5965 RENAISSANCE PL
Mailing Address - Street 2:BLDG 3
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4709
Mailing Address - Country:US
Mailing Address - Phone:419-885-0900
Mailing Address - Fax:419-824-6447
Practice Address - Street 1:5965 RENAISSANCE PL
Practice Address - Street 2:BLDG 3
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4709
Practice Address - Country:US
Practice Address - Phone:419-885-0900
Practice Address - Fax:419-824-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2656513Medicaid
OHDB3333OtherRAILROAD MEDICARE
OH000000323550OtherANTHEM
OHDB3333OtherRAILROAD MEDICARE
OH000000323550OtherANTHEM