Provider Demographics
NPI:1285820977
Name:POWELL FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:POWELL FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BREZNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-766-4900
Mailing Address - Street 1:10330 SAWMILL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7790
Mailing Address - Country:US
Mailing Address - Phone:614-766-4900
Mailing Address - Fax:614-766-4984
Practice Address - Street 1:10330 SAWMILL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7790
Practice Address - Country:US
Practice Address - Phone:614-766-4900
Practice Address - Fax:614-766-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351940Medicaid
OHPO9327821OtherMEDICARE ID