Organization · NPI-2

Family Statcare Of Northeast Ohio, LLC

Nurse Practitioner · Wadsworth, OH

NPI number1053565986

StatusActive

Last updated in NPPESMar 26, 2015

Details

NPI: 1053565986
Entity type: Organization (NPI-2)
Legal business name: Family Statcare Of Northeast Ohio, LLC
Organization subpart: No
Enumeration date: Nov 5, 2008
Last updated: Mar 26, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363L00000X	Nurse Practitioner	–	–	Yes
363A00000X	Physician Assistant	–	–

Practice location

175 Great Oaks Trl
Wadsworth, OH 44281-8712

Phone 330-336-3588 · Fax 330-336-1328

Mailing address

230 Quadral Dr
Suite B
Wadsworth, OH 44281-8376

Phone 330-336-3280 · Fax 330-336-5325

Authorized official

Ken Filbert
Owner
3304166153

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