Provider Demographics
NPI:1851485700
Name:EATON FAMILY CARE CENTER
Entity Type:Organization
Organization Name:EATON FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-456-4181
Mailing Address - Street 1:550 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-8648
Mailing Address - Country:US
Mailing Address - Phone:937-456-4181
Mailing Address - Fax:937-456-4649
Practice Address - Street 1:550 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8648
Practice Address - Country:US
Practice Address - Phone:937-456-4181
Practice Address - Fax:937-456-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052844Medicaid
OH9257442Medicare ID - Type Unspecified