Provider Demographics
NPI:1841404977
Name:THE FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:THE FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:AU
Authorized Official - Last Name:ROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-619-5006
Mailing Address - Street 1:3260 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5107
Mailing Address - Country:US
Mailing Address - Phone:513-389-1400
Mailing Address - Fax:
Practice Address - Street 1:3260 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5107
Practice Address - Country:US
Practice Address - Phone:513-389-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty