Provider Demographics
NPI:1760649750
Name:PARK AVENUE FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:PARK AVENUE FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BINNS
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:740-852-0938
Mailing Address - Street 1:55 PARK AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1121
Mailing Address - Country:US
Mailing Address - Phone:740-852-0938
Mailing Address - Fax:
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:STE 250
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1121
Practice Address - Country:US
Practice Address - Phone:740-852-0938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty