Provider Demographics
NPI:1760502074
Name:EAST LIVERPOOL FAMILY PRACTICE, LTD.
Entity Type:Organization
Organization Name:EAST LIVERPOOL FAMILY PRACTICE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-386-3311
Mailing Address - Street 1:16494 SAINT CLAIR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9400
Mailing Address - Country:US
Mailing Address - Phone:330-386-3311
Mailing Address - Fax:
Practice Address - Street 1:16494 SAINT CLAIR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9400
Practice Address - Country:US
Practice Address - Phone:330-386-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3400490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743548Medicaid
OH0743548Medicaid
OH9311271Medicare PIN
OH0743548Medicaid