=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669086260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CARE PLUS CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2020
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 297 N MAIN ST STE 7
-----------------------------------------------------
City | MUNROE FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44262-1077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-765-4141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4490 DARROW RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-765-4141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. NANCY NAGHAVI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 330-765-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------