Provider Demographics
NPI:1497711055
Name:FAMILY & SPORTS MEDICINE, INC
Entity Type:Organization
Organization Name:FAMILY & SPORTS MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-523-6329
Mailing Address - Street 1:110 SELHORST DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1561
Mailing Address - Country:US
Mailing Address - Phone:800-204-0099
Mailing Address - Fax:
Practice Address - Street 1:110 SELHORST DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1561
Practice Address - Country:US
Practice Address - Phone:419-523-6329
Practice Address - Fax:419-523-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9248911Medicare ID - Type UnspecifiedMEDICARE