MEDICARE: LEAHY FAMILY CARE 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	261QP2300X	Primary Care Clinic/Center

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	:	1902918030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAHY FAMILY CARE INC

Provider Business Mailing Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

Provider Business Practice Location Address
First Line	:	825 S CABLE RD
Second Line	:	SUITE A
City	:	LIMA
State	:	OH
Zip	:	45805-3467
Country	:	US
Telephone Number	:	419-224-1234
Fax Number	:	419-224-6800

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM J LEAHY
Credential	:	MD
Telephone Number	:	419-224-1234

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “LEAHY FAMILY CARE INC ” Practice Location

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