Provider Demographics
NPI:1902918030
Name:LEAHY FAMILY CARE INC
Entity Type:Organization
Organization Name:LEAHY FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-224-1234
Mailing Address - Street 1:825 S CABLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3467
Mailing Address - Country:US
Mailing Address - Phone:419-224-1234
Mailing Address - Fax:419-224-6800
Practice Address - Street 1:825 S CABLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3467
Practice Address - Country:US
Practice Address - Phone:419-224-1234
Practice Address - Fax:419-224-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2156518Medicaid
OH2156518Medicaid
OHLE9358721Medicare ID - Type Unspecified