MEDICARE: FAMILY PRACTICE CENTER OF LOUISVILLE, 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	174400000X	Specialist		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	285505380-00	OTHER	OH	WORKERS COMPENSATION
2	000000164947	OTHER	OH	ANTHEM GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497700850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE CENTER OF LOUISVILLE, INC

Provider Business Mailing Address
First Line	:	1303 CALIFORNIA AVE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-8737
Country	:	US
Telephone Number	:	330-875-3353
Fax Number	:	330-875-2746

Provider Business Practice Location Address
First Line	:	1303 CALIFORNIA AVE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-8737
Country	:	US
Telephone Number	:	330-875-3353
Fax Number	:	330-875-2746

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CATHARINE J TABB
Credential	:	M.D
Telephone Number	:	330-875-3353

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/21/2022

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Directions to “FAMILY PRACTICE CENTER OF LOUISVILLE, INC ” Practice Location

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