Basic Information
| Provider Information | |||||||||
| NPI: | 1568503662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATIONS FAMILY MEDICINE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 N HAMILTON RD | ||||||||
| Address2: | STE. 255 | ||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432308703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143379100 | ||||||||
| FaxNumber: | 6143370027 | ||||||||
| Practice Location | |||||||||
| Address1: | 765 N HAMILTON RD | ||||||||
| Address2: | STE. 255 | ||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432308703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143379100 | ||||||||
| FaxNumber: | 6143370027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | GAUGHAN | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OFFICE BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6143379100 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 0844288 | 05 | OH | MEDICAID |