Provider Demographics
NPI:1669550182
Name:FAMILY PHYSICIANS OF LIMA INC
Entity type:Organization
Organization Name:FAMILY PHYSICIANS OF LIMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRENDL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-991-7805
Mailing Address - Street 1:2875 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-991-7805
Mailing Address - Fax:419-991-7862
Practice Address - Street 1:119 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45887
Practice Address - Country:US
Practice Address - Phone:419-647-4165
Practice Address - Fax:419-647-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1710972047OtherNPI ERIC T STALLKAMP MD
OH0823854OtherMEDICAID, GROUP #
OH1184619595OtherNPI ELISE D CLARK CNP
OH9934001OtherMEDICARE, GROUP #
OH1134112469OtherGROUP NPI#, PRIMARY OFFIC
OH1346235728OtherNPI CHRISTINE R GAYNIER M
OH1215941711OtherNPI TRACY L SHARP DO
OH1831183896OtherNPI KARRI L KRENDL MD