Provider Demographics
NPI:1598969214
Name:OHIO FAMILY PRACTICE CENTERS, INC
Entity Type:Organization
Organization Name:OHIO FAMILY PRACTICE CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-836-8471
Mailing Address - Street 1:3009 SMITH ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3766
Mailing Address - Country:US
Mailing Address - Phone:330-836-8471
Mailing Address - Fax:330-665-5840
Practice Address - Street 1:3009 SMITH ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3766
Practice Address - Country:US
Practice Address - Phone:330-836-8471
Practice Address - Fax:330-665-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH55000051CTPOtherSTATE LICENSE
OH1598969214OtherGROUP NPI
OH2283176Medicaid
OH35092267COtherSTATE LICENSE
OH35070564SOtherSTATE LICENSE
OH35077042DOtherSTATE LICENSE
OH0276133Medicaid
OH2369217Medicaid
OH2973420Medicaid
OH1164694758OtherNPI
OH1548238454OtherNPI
OH1770551509OtherNPI
OH1891763058OtherNPI
OHG49502Medicare UPIN
OH2973420Medicaid
0821383Medicare PIN
4247271Medicare PIN
OHG84390Medicare UPIN
OHH48681Medicare UPIN