Basic Information
| Provider Information | |||||||||
| NPI: | 1053393181 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE CARE FAMILY PRACTICE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4126 N HOLLAND SYLVANIA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194739500 | ||||||||
| FaxNumber: | 4194739501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4126 N HOLLAND SYLVANIA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194739500 | ||||||||
| FaxNumber: | 4194739501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 01/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4194739500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | DA3156 | 01 | OH | RAILROAD MEDICARE | OTHER | 2413392 | 05 | OH | MEDICAID |