Provider Demographics
NPI:1649392275
Name:CENTER FOR FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-746-3088
Mailing Address - Street 1:333 CONOVER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1900
Mailing Address - Country:US
Mailing Address - Phone:937-746-3088
Mailing Address - Fax:937-746-8752
Practice Address - Street 1:333 CONOVER DR
Practice Address - Street 2:SUITE E
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1900
Practice Address - Country:US
Practice Address - Phone:937-746-3088
Practice Address - Fax:937-746-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333693Medicaid
OHCE9325621Medicare ID - Type Unspecified