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Organization
SHELBY FAMILY MEDICINE INC
Active
Organization
SHELBY FAMILY MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA I LONG (TREASURER/OFFICE MANAGER)
(419) 347-4040
Entity
Organization
Contact information
Practice address
24 MORRIS RD, SUITE 1, SHELBY, OH 44875-1152
(419) 347-4040
Mailing address
142 GLENWOOD DR, SHELBY, OH 44875-1838
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35049038L
OH
Other
Enumeration date
09/13/2007
Last updated
09/13/2007
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