Provider Demographics
NPI:1922159524
Name:RICHLAND FAMILY PRACTICE, LTD
Entity Type:Organization
Organization Name:RICHLAND FAMILY PRACTICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-524-1410
Mailing Address - Street 1:680 PARK AVE W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3706
Mailing Address - Country:US
Mailing Address - Phone:419-524-1410
Mailing Address - Fax:419-524-2202
Practice Address - Street 1:680 PARK AVE W
Practice Address - Street 2:SUITE 204
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3706
Practice Address - Country:US
Practice Address - Phone:419-524-1410
Practice Address - Fax:419-524-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRI9306071Medicare ID - Type UnspecifiedFAMILY PRACTICE