Provider Demographics
NPI:1245572866
Name:FAMILY HEALTH PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOINOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-821-4455
Mailing Address - Street 1:2565 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5058
Mailing Address - Country:US
Mailing Address - Phone:330-821-4455
Mailing Address - Fax:330-821-4504
Practice Address - Street 1:2565 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5058
Practice Address - Country:US
Practice Address - Phone:330-821-4455
Practice Address - Fax:330-821-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.082293207QS0010X, 332B00000X
OHCOA.14388-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH180460Medicare PIN