Provider Demographics
NPI:1508038068
Name:PEOPLES FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:PEOPLES FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-328-8074
Mailing Address - Street 1:1279 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3300
Mailing Address - Country:US
Mailing Address - Phone:614-884-7108
Mailing Address - Fax:614-884-7109
Practice Address - Street 1:1279 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE 100C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3300
Practice Address - Country:US
Practice Address - Phone:614-884-7108
Practice Address - Fax:614-884-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-8587-N208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA15954Medicare UPIN
OHNJ0561816Medicare PIN