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General NPI Number Information
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NPI Number | 1013106467
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Entity Type | Organization
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Legal Business Name | WARREN FAMILY MEDICAL, INC.
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 8700 E MARKET ST SUITE 4
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City | WARREN
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State | OH
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Zip | 44484-2340
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Country | US
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Telephone | 330-856-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 E MARKET ST SUITE 4
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City | WARREN
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State | OH
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Zip | 44484-2340
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Country | US
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Telephone | 330-856-7702
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FAREEDAH ZAKIYYAH GOODWIN
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Credential | M.D.
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Telephone | 330-856-7702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 85291
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License Number State | OH
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