Provider Demographics
NPI:1861458044
Name:HILLIARD FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:HILLIARD FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JEU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-876-7330
Mailing Address - Street 1:3958 LEAP RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1114
Mailing Address - Country:US
Mailing Address - Phone:614-876-7330
Mailing Address - Fax:614-876-6974
Practice Address - Street 1:3958 LEAP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1114
Practice Address - Country:US
Practice Address - Phone:614-876-7330
Practice Address - Fax:614-876-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0869314Medicaid
OHJ09925961Medicare ID - Type UnspecifiedMEDICARE GROUP ID
OHA80278Medicare UPIN
OHG25544Medicare UPIN
OH0869314Medicaid
OHI39901Medicare UPIN
OHG12222Medicare UPIN