MEDICARE: WARREN FAMILY MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	85291	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013106467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN FAMILY MEDICAL, INC.

Provider Business Mailing Address
First Line	:	8700 E MARKET ST
Second Line	:	SUITE 4
City	:	WARREN
State	:	OH
Zip	:	44484-2340
Country	:	US
Telephone Number	:	330-856-7702
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 E MARKET ST
Second Line	:	SUITE 4
City	:	WARREN
State	:	OH
Zip	:	44484-2340
Country	:	US
Telephone Number	:	330-856-7702
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FAREEDAH ZAKIYYAH GOODWIN
Credential	:	M.D.
Telephone Number	:	330-856-7702

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	01/12/2011

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