MEDICARE: AFFINITY FAMILY PRACTICE CENTER

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	207Q00000X	Family Medicine Physician	34008128	OH
2	207Q00000X	Family Medicine Physician	34008892	OH
3	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	34002743	OH
4	207Q00000X	Family Medicine Physician	34006265	OH
5	207Q00000X	Family Medicine Physician	34002356	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245273911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY FAMILY PRACTICE CENTER

Provider Business Mailing Address
First Line	:	365 S CROWN HILL RD
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9527
Country	:	US
Telephone Number	:	330-682-3075
Fax Number	:	330-682-7454

Provider Business Practice Location Address
First Line	:	365 S CROWN HILL RD
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9527
Country	:	US
Telephone Number	:	330-682-3075
Fax Number	:	330-682-7454

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	BECKY J DURBIN
Credential	:	OFFICE MANGER
Telephone Number	:	330-682-3075

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/09/2013

Similar Medicare Providers

1457356248 — DR. SEAN MICHAEL CAMP D.C.
Practice Location Address:

345 S CROWN HILL RD
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-6876
Practice Fax: 330-683-0836

1770560534 — CHARLES D MILLIGAN D.O.
Practice Location Address:

365 S CROWN HILL RD
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-3075
Practice Fax: 330-682-7454

1902883507 — DOUGLAS R BROWN D.O.
Practice Location Address:

365 S CROWN HILL RD
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-3075
Practice Fax: 330-682-7454

1427085844 — MATTHEW PAUL WAYT PA-C
Practice Location Address:

365 S CROWN HILL RD
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-3075
Practice Fax: 330-682-7454

1821110685 — LISA ANN DALESSANDRO M.T.
Practice Location Address:

345 S CROWN HILL RD
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-6876
Practice Fax: 330-683-0836

1558517706 — MRS. JAMIE LYNN PLATZ ATC
Practice Location Address:

832 S MAIN ST , DUNLAP COMMUNITY HOSPITAL
ORRVILLE, OH
44667-9527

Practice Phone: 330-682-3010
Practice Fax: 330-684-4742

Directions to “AFFINITY FAMILY PRACTICE CENTER ” Practice Location

Language	Start Address	Practice Location

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