Healthcare Provider Details

I. General information

NPI: 1477650430
Provider Name (Legal Business Name): OLMO FAMILY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 GRANVILLE ST
GAHANNA OH
43230-3000
US

IV. Provider business mailing address

98 GRANVILLE ST
GAHANNA OH
43230-3000
US

V. Phone/Fax

Practice location:
  • Phone: 614-428-8585
  • Fax: 614-428-7784
Mailing address:
  • Phone: 614-428-8585
  • Fax: 614-428-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number35068219
License Number StateOH

VIII. Authorized Official

Name: MR. FRANKLIN ALFREDO OLMO
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 614-428-8585