Provider Demographics
NPI:1609934611
Name:CORTLAND FAMILY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CORTLAND FAMILY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-638-6121
Mailing Address - Street 1:151 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1450
Mailing Address - Country:US
Mailing Address - Phone:330-638-6121
Mailing Address - Fax:
Practice Address - Street 1:151 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1450
Practice Address - Country:US
Practice Address - Phone:330-638-6121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1369261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2882500Medicaid
OH2882500Medicaid
OHFO0012565Medicare PIN