Provider Demographics
NPI:1922106673
Name:NORTHERN OHIO FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:NORTHERN OHIO FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-668-1101
Mailing Address - Street 1:257 BENEDICT AVE
Mailing Address - Street 2:BUILDING C, SUITE 1
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2715
Mailing Address - Country:US
Mailing Address - Phone:419-668-1101
Mailing Address - Fax:419-668-1191
Practice Address - Street 1:257 BENEDICT AVE
Practice Address - Street 2:BUILDING C, SUITE 1
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2715
Practice Address - Country:US
Practice Address - Phone:419-668-1101
Practice Address - Fax:419-668-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2447016Medicaid
OH2447016Medicaid
OH2447016Medicaid
OH2343333Medicaid
OHSPNP28721Medicare PIN
OHBENP10931Medicare ID - Type UnspecifiedREBECCA BECK
OH9328711Medicare PIN