Basic Information
| Provider Information | |||||||||
| NPI: | 1487945283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE FAMILY MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3260 WESTBOURNE DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452485107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133891400 | ||||||||
| FaxNumber: | 5133472112 | ||||||||
| Practice Location | |||||||||
| Address1: | 3260 WESTBOURNE DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452485107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133891400 | ||||||||
| FaxNumber: | 5136198713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | TONEY | ||||||||
| AuthorizedOfficialFirstName: | MEGHAN | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5133891400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.