| Ohio Family Practice Centers, Inc | |
|
3009 Smith Road Suite 200 Fairlawn OH 44333-3766 | |
| (330) 836-8471 | |
| (330) 665-5840 |
| Full Name | Ohio Family Practice Centers, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3009 Smith Road, Fairlawn, Ohio |
| Authorized Official Name and Position | Kathy Wiczen (OFFICE MANAGER) |
| Authorized Official Contact | 3308368471 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ohio Family Practice Centers, Inc 3009 Smith Road Suite 200 Fairlawn OH 44333-3766 Ph: (330) 836-8471 | Ohio Family Practice Centers, Inc 3009 Smith Road Suite 200 Fairlawn OH 44333-3766 Ph: (330) 836-8471 |
| NPI Number | 1598969214 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 05/13/2016 |
| Medicare PECOS PAC ID | 7618865940 |
|---|---|
| Medicare Enrollment ID | O20040309000187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598969214 | NPI | - | NPPES |
| 55000051CTP | Other | OH | STATE LICENSE |
| 1598969214 | Other | OH | GROUP NPI |
| 2283176 | Medicaid | OH | |
| 35092267C | Other | OH | STATE LICENSE |
| 35070564S | Other | OH | STATE LICENSE |
| 35077042D | Other | OH | STATE LICENSE |
| 0276133 | Medicaid | OH | |
| 2369217 | Medicaid | OH | |
| 2973420 | Medicaid | OH | |
| 1164694758 | Other | OH | NPI |
| 1548238454 | Other | OH | NPI |
| 1770551509 | Other | OH | NPI |
| 1891763058 | Other | OH | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard James Domdera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891763058 PECOS PAC ID: 6800784034 Enrollment ID: I20040310000077 |
| Provider Name | Kelli Sabin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548238454 PECOS PAC ID: 1254229487 Enrollment ID: I20040317000093 |
| Provider Name | Jennifer Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871149864 PECOS PAC ID: 9032448238 Enrollment ID: I20190913001040 |
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