Provider Demographics
NPI:1700973492
Name:PERRYSBURG FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:PERRYSBURG FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WIREBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-872-7600
Mailing Address - Street 1:702 COMMERCE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5239
Mailing Address - Country:US
Mailing Address - Phone:419-872-7600
Mailing Address - Fax:419-872-7601
Practice Address - Street 1:702 COMMERCE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5239
Practice Address - Country:US
Practice Address - Phone:419-872-7600
Practice Address - Fax:419-872-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050638W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9354521Medicare PIN