Provider Demographics
NPI:1578563631
Name:FAMILY PHYSICIANS ASSOCIATED
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS ASSOCIATED
Other - Org Name:FAMILY PHYSICIANS ASSOCIATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:OBANION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-563-7421
Mailing Address - Street 1:1025 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1425
Mailing Address - Country:US
Mailing Address - Phone:260-563-7421
Mailing Address - Fax:260-563-7725
Practice Address - Street 1:1025 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1425
Practice Address - Country:US
Practice Address - Phone:260-563-7421
Practice Address - Fax:260-563-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
228540Medicare ID - Type Unspecified
Q45257Medicare UPIN