Provider Demographics
NPI:1477650430
Name:OLMO FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:OLMO FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-428-8585
Mailing Address - Street 1:98 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3000
Mailing Address - Country:US
Mailing Address - Phone:614-428-8585
Mailing Address - Fax:614-428-7784
Practice Address - Street 1:98 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3000
Practice Address - Country:US
Practice Address - Phone:614-428-8585
Practice Address - Fax:614-428-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068219261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221067Medicaid
OH0221067Medicaid
OHG20980Medicare UPIN