Healthcare Provider Details

I. General information

NPI: 1669550182
Provider Name (Legal Business Name): FAMILY PHYSICIANS OF LIMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S BROADWAY
SPENCERVILLE OH
45887
US

IV. Provider business mailing address

2875 W ELM ST
LIMA OH
45805
US

V. Phone/Fax

Practice location:
  • Phone: 419-647-4165
  • Fax: 419-647-4183
Mailing address:
  • Phone: 419-991-7805
  • Fax: 419-991-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KARRI L KRENDL
Title or Position: OWNER
Credential: M.D.
Phone: 419-991-7805