MEDICARE: THORNVILLE FAMILY MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447226931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORNVILLE FAMILY MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-0550
Country	:	US
Telephone Number	:	740-687-5164
Fax Number	:	740-654-1417

Provider Business Practice Location Address
First Line	:	41 FOSTER DR
Second Line	:
City	:	THORNVILLE
State	:	OH
Zip	:	43076
Country	:	US
Telephone Number	:	740-246-6361
Fax Number	:	740-246-4722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LARRY I COWAN
Credential	:	DO
Telephone Number	:	740-246-6361

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	03/16/2010

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