Healthcare Provider Details

I. General information

NPI: 1629436431
Provider Name (Legal Business Name): AMERICAN FAMILY CARE OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 PAXTON AVE STE. 1
CINCINNATI OH
45209-2399
US

IV. Provider business mailing address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

V. Phone/Fax

Practice location:
  • Phone: 513-559-9700
  • Fax: 513-559-0900
Mailing address:
  • Phone: 205-421-2098
  • Fax: 205-421-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: RANDY JOHANSEN
Title or Position: PRESIDENT
Credential:
Phone: 205-403-8902