Provider Demographics
NPI:1629275003
Name:ARLINGTON FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:ARLINGTON FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FRESHWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-365-5153
Mailing Address - Street 1:906 N. MAIN STREET
Mailing Address - Street 2:P.O. BOX 319
Mailing Address - City:ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45814-0319
Mailing Address - Country:US
Mailing Address - Phone:419-365-5153
Mailing Address - Fax:419-365-0081
Practice Address - Street 1:906 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:45814-0319
Practice Address - Country:US
Practice Address - Phone:419-365-5153
Practice Address - Fax:419-365-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922658Medicaid
OHAR 9267401Medicare ID - Type Unspecified
C10826Medicare PIN