Provider Demographics
NPI:1285878173
Name:SYLVANIA FAMILY HEALTH AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:SYLVANIA FAMILY HEALTH AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-885-8822
Mailing Address - Street 1:7135 SYLVANIA AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-5510
Mailing Address - Country:US
Mailing Address - Phone:419-885-8822
Mailing Address - Fax:419-885-9221
Practice Address - Street 1:7135 SYLVANIA AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-5510
Practice Address - Country:US
Practice Address - Phone:419-885-8822
Practice Address - Fax:419-885-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty