Healthcare Provider Details

I. General information

NPI: 1023007655
Provider Name (Legal Business Name): PHYSICIANS IN FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W LORAIN ST
OBERLIN OH
44074
US

IV. Provider business mailing address

319 W LORAIN ST
OBERLIN OH
44074
US

V. Phone/Fax

Practice location:
  • Phone: 440-775-1881
  • Fax: 440-774-5707
Mailing address:
  • Phone: 440-775-1881
  • Fax: 440-774-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN M JONESCO
Title or Position: PRESIDENT
Credential: DO
Phone: 440-775-1881