Healthcare Provider Details

I. General information

NPI: 1245273911
Provider Name (Legal Business Name): AFFINITY FAMILY PRACTICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S CROWN HILL RD
ORRVILLE OH
44667-9527
US

IV. Provider business mailing address

365 S CROWN HILL RD
ORRVILLE OH
44667-9527
US

V. Phone/Fax

Practice location:
  • Phone: 330-682-3075
  • Fax: 330-682-7454
Mailing address:
  • Phone: 330-682-3075
  • Fax: 330-682-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008128
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008892
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34002743
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006265
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002356
License Number StateOH

VIII. Authorized Official

Name: BECKY J DURBIN
Title or Position: OFFICE MANGER
Credential: OFFICE MANGER
Phone: 330-682-3075