=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700680915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHMAN FAMILY LIVING MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7160 CHAGRIN RD
-----------------------------------------------------
City | CHAGRIN FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44023-1134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-338-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 265
-----------------------------------------------------
City | NEWBURY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44065-0265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-338-2320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | KURT INGERSOLL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-338-2320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------