Provider Demographics
NPI:1760671499
Name:INMAN FAMILY HEALTH & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INMAN FAMILY HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-627-8163
Mailing Address - Street 1:125 CANTON RD NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1009
Mailing Address - Country:US
Mailing Address - Phone:330-627-8163
Mailing Address - Fax:330-627-0197
Practice Address - Street 1:125 CANTON RD NW
Practice Address - Street 2:SUITE A
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1009
Practice Address - Country:US
Practice Address - Phone:330-627-8163
Practice Address - Fax:330-627-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2617654Medicaid
OH2617654Medicaid