Provider Demographics
NPI:1952403776
Name:MAUMEE BAY FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:MAUMEE BAY FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-691-7820
Mailing Address - Street 1:4330 NAVARRE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3578
Mailing Address - Country:US
Mailing Address - Phone:419-691-7820
Mailing Address - Fax:419-691-7593
Practice Address - Street 1:4330 NAVARRE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3578
Practice Address - Country:US
Practice Address - Phone:419-691-7820
Practice Address - Fax:419-691-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078608R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343128Medicaid
OH724392Medicaid
OH2343128Medicaid
OHCH2545Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER
OH724392Medicaid