Organization
OHIO FAMILY PRACTICE CENTERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY WICZEN (OFFICE MANAGER)
(330) 836-8471
Entity
Organization
Contact information
Practice address
3009 SMITH ROAD, SUITE 200, FAIRLAWN, OH 44333-3766
(330) 836-8471
(330) 665-5840
Mailing address
3009 SMITH ROAD, SUITE 200, FAIRLAWN, OH 44333-3766
(330) 836-8471
(330) 665-5840
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0276133
—
OH
01
—
1164694758
NPI
OH
01
—
1548238454
NPI
OH
01
—
1598969214
GROUP NPI
OH
01
—
1770551509
NPI
OH
01
—
1891763058
NPI
OH
05
—
2283176
—
OH
05
—
2369217
—
OH
05
—
2973420
—
OH
01
—
35070564S
STATE LICENSE
OH
01
—
35077042D
STATE LICENSE
OH
01
—
35092267C
STATE LICENSE
OH
01
—
55000051CTP
STATE LICENSE
OH
Enumeration date
06/14/2007
Last updated
05/13/2016
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