Provider Demographics
NPI:1285746826
Name:FAMILY MEDICINE FOUNDATION LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-293-2653
Mailing Address - Street 1:2231 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1101
Mailing Address - Country:US
Mailing Address - Phone:614-293-2653
Mailing Address - Fax:614-293-2715
Practice Address - Street 1:2231 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1101
Practice Address - Country:US
Practice Address - Phone:614-293-2653
Practice Address - Fax:614-293-2715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSU PHYSICIANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty