Provider Demographics
NPI:1598040586
Name:FRANK FAMILY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:FRANK FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-253-3003
Mailing Address - Street 1:4550 STATE ROUTE 229
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9687
Mailing Address - Country:US
Mailing Address - Phone:419-253-3003
Mailing Address - Fax:419-253-2153
Practice Address - Street 1:4550 STATE ROUTE 229
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9687
Practice Address - Country:US
Practice Address - Phone:419-253-3003
Practice Address - Fax:419-253-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058738Medicaid
OH0058738Medicaid
OHDS1610Medicare PIN