Provider Demographics
NPI:1932575735
Name:BAIR FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:BAIR FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-856-1035
Mailing Address - Street 1:8700 E MARKET ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2340
Mailing Address - Country:US
Mailing Address - Phone:330-856-1035
Mailing Address - Fax:330-856-6500
Practice Address - Street 1:8700 E MARKET ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2340
Practice Address - Country:US
Practice Address - Phone:330-856-1035
Practice Address - Fax:330-856-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty