Provider Demographics
NPI:1912965674
Name:ADAMS FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ADAMS FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:614-873-3434
Mailing Address - Street 1:200 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7515
Mailing Address - Country:US
Mailing Address - Phone:614-793-1980
Mailing Address - Fax:614-793-1985
Practice Address - Street 1:480 S JEFFERSON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-4137
Practice Address - Country:US
Practice Address - Phone:614-873-3434
Practice Address - Fax:614-873-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0601521Medicaid
OHAD9281761Medicare PIN