Provider Demographics
NPI:1063497832
Name:GEAUGA FAMILY PHYSICIANS, INC
Entity type:Organization
Organization Name:GEAUGA FAMILY PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MORITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-286-6155
Mailing Address - Street 1:13221 RAVENNA RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9047
Mailing Address - Country:US
Mailing Address - Phone:440-286-6155
Mailing Address - Fax:440-286-6156
Practice Address - Street 1:13221 RAVENNA RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9047
Practice Address - Country:US
Practice Address - Phone:440-286-6155
Practice Address - Fax:440-286-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2071985Medicaid
OHCG9215OtherRAILROAD MEDICARE
OHCG9215OtherRAILROAD MEDICARE
OH2071985Medicaid