Provider Demographics
NPI:1467433888
Name:FAMILY MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-652-1759
Mailing Address - Street 1:1150 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446
Mailing Address - Country:US
Mailing Address - Phone:330-652-1759
Mailing Address - Fax:330-652-2719
Practice Address - Street 1:1150 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446
Practice Address - Country:US
Practice Address - Phone:330-652-1759
Practice Address - Fax:330-652-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0641872Medicaid
FA9920931Medicare ID - Type Unspecified