Provider Demographics
NPI:1760658058
Name:COMPLETE FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:COMPLETE FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARILLARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-729-9514
Mailing Address - Street 1:7000 SOUTH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3644
Mailing Address - Country:US
Mailing Address - Phone:330-729-9514
Mailing Address - Fax:330-729-9591
Practice Address - Street 1:7000 SOUTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3644
Practice Address - Country:US
Practice Address - Phone:330-729-9514
Practice Address - Fax:330-729-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2840840Medicaid
OH2840840Medicaid