Provider Demographics
NPI:1689970527
Name:FAMILY HEALTH SERVICES OF ERIE COUNTY
Entity Type:Organization
Organization Name:FAMILY HEALTH SERVICES OF ERIE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TATRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-502-2822
Mailing Address - Street 1:1912 HAYES AVENUE
Mailing Address - Street 2:POST OFFICE BOX 1526
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-502-2822
Mailing Address - Fax:419-502-2821
Practice Address - Street 1:1912 HAYES AVENUE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-557-7189
Practice Address - Fax:419-557-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3119682Medicaid