Provider Demographics
NPI:1912066499
Name:METROPOLITAN FAMILY CARE, INC.
Entity Type:Organization
Organization Name:METROPOLITAN FAMILY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRFA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-237-1067
Mailing Address - Street 1:3341 E LIVINGSTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1949
Mailing Address - Country:US
Mailing Address - Phone:614-237-1067
Mailing Address - Fax:614-237-2655
Practice Address - Street 1:3341 E LIVINGSTON AVE STE D
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1949
Practice Address - Country:US
Practice Address - Phone:614-237-1067
Practice Address - Fax:614-237-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0802000Medicaid
OH0802000Medicaid