Provider Demographics
NPI:1386140069
Name:EHRHART FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:EHRHART FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:EHRHART BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:740-778-1818
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45682-0483
Mailing Address - Country:US
Mailing Address - Phone:740-778-1818
Mailing Address - Fax:740-778-1819
Practice Address - Street 1:11016 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEBSTER
Practice Address - State:OH
Practice Address - Zip Code:45682-7501
Practice Address - Country:US
Practice Address - Phone:740-448-1818
Practice Address - Fax:740-778-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care