Provider Demographics
NPI:1861574873
Name:CELINA FAMILY PRACTICE
Entity type:Organization
Organization Name:CELINA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-586-3113
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-0420
Mailing Address - Country:US
Mailing Address - Phone:419-586-3113
Mailing Address - Fax:419-586-6560
Practice Address - Street 1:724 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:HI
Practice Address - Zip Code:45822-0420
Practice Address - Country:US
Practice Address - Phone:419-586-3113
Practice Address - Fax:419-586-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI4551168OtherAETNA
HI0609854Medicaid
HI0609854Medicaid
HI0609854Medicaid