Provider Demographics
NPI:1487951836
Name:MASON FAMILY MEDICINE & ASSOCIATES LLC
Entity type:Organization
Organization Name:MASON FAMILY MEDICINE & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-2111
Mailing Address - Street 1:6394 THORNBERRY CT
Mailing Address - Street 2:SUITE 820
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7810
Mailing Address - Country:US
Mailing Address - Phone:513-492-8541
Mailing Address - Fax:513-492-8542
Practice Address - Street 1:6394 THORNBERRY CT
Practice Address - Street 2:SUITE 820
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7810
Practice Address - Country:US
Practice Address - Phone:513-492-8541
Practice Address - Fax:513-492-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty