Provider Demographics
NPI:1427306414
Name:COMPREHENSIVE FAMILY PRACTICE OF COLUMBIANA LLC
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY PRACTICE OF COLUMBIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:330-410-3688
Mailing Address - Street 1:1026 WILLIAMS RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9317
Mailing Address - Country:US
Mailing Address - Phone:330-449-3300
Mailing Address - Fax:330-449-3301
Practice Address - Street 1:1026 WILLIAMS RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9317
Practice Address - Country:US
Practice Address - Phone:330-449-3300
Practice Address - Fax:330-449-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4014037Medicare PIN