Healthcare Provider Details

I. General information

NPI: 1851485700
Provider Name (Legal Business Name): EATON FAMILY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HALLMARK DR
EATON OH
45320-8648
US

IV. Provider business mailing address

550 HALLMARK DR
EATON OH
45320-8648
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-4181
  • Fax: 937-456-4649
Mailing address:
  • Phone: 937-456-4181
  • Fax: 937-456-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: PATRICIA ESHAM
Title or Position: ORGANIZATION MANAGER
Credential:
Phone: 937-456-4181