Provider Demographics
NPI:1013106467
Name:WARREN FAMILY MEDICAL, INC.
Entity type:Organization
Organization Name:WARREN FAMILY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAREEDAH
Authorized Official - Middle Name:ZAKIYYAH
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-7702
Mailing Address - Street 1:8700 E MARKET ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2340
Mailing Address - Country:US
Mailing Address - Phone:330-856-7702
Mailing Address - Fax:
Practice Address - Street 1:8700 E MARKET ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2340
Practice Address - Country:US
Practice Address - Phone:330-856-7702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85291261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2985328Medicaid
OH9357061Medicare PIN
OHI42440Medicare UPIN