Provider Demographics
NPI:1982696514
Name:OHIO FAMILY HEALTH CARE ASSOCIATES IN
Entity Type:Organization
Organization Name:OHIO FAMILY HEALTH CARE ASSOCIATES IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-792-5283
Mailing Address - Street 1:1570 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4077
Mailing Address - Country:US
Mailing Address - Phone:330-792-5283
Mailing Address - Fax:330-792-0183
Practice Address - Street 1:1570 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4077
Practice Address - Country:US
Practice Address - Phone:330-792-5283
Practice Address - Fax:330-792-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922587Medicaid
OH0922587Medicaid