Healthcare Provider Details

I. General information

NPI: 1285815712
Provider Name (Legal Business Name): IGNARSKI FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HIGH ST STE 390
LIMA OH
45801-3997
US

IV. Provider business mailing address

750 W HIGH ST STE 390
LIMA OH
45801-3997
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-8432
  • Fax: 419-222-9057
Mailing address:
  • Phone: 419-222-8432
  • Fax: 419-222-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number35076123
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2145806
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MRS. LORY S IGNARSKI
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 419-222-8432