Provider Demographics
NPI:1265626188
Name:FAMILY MEDICINE ASSOCIATES OF SANDUSKY CO LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF SANDUSKY CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GREENSLADE
Authorized Official - Last Name:HOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-355-9440
Mailing Address - Street 1:1479 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9760
Mailing Address - Country:US
Mailing Address - Phone:419-355-9440
Mailing Address - Fax:419-355-9443
Practice Address - Street 1:1479 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9760
Practice Address - Country:US
Practice Address - Phone:419-355-9440
Practice Address - Fax:419-355-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA5652OtherMEDICARE RAILROAD
OH2421016Medicaid
OH9337412Medicare PIN
OH9337411Medicare PIN