Fremont Family Medicine, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-084980 Issued in OH

Legal business name

FREMONT FAMILY MEDICINE, INC.

Practice address

1916 Glen Springs Dr
Fremont, OH 43420-3293

Phone

(419) 332-4223

Fax

(419) 332-9099

NPI assigned

Aug 23, 2007

Last updated

Oct 21, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Denise K Woolley, CPMSP, CPCS

Title

Director, Medical Staff Services

Phone

(419) 334-6624

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1124211172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 GLEN SPRINGS DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203293",
            "telephone_number": "419-332-4223",
            "fax_number": "419-332-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 GLEN SPRINGS DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203293",
            "telephone_number": "419-332-4223",
            "fax_number": "419-332-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT FAMILY MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "WOOLLEY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR, MEDICAL STAFF SERVICES",
        "authorized_official_telephone_number": "419-334-6624",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPMSP, CPCS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-084980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION CERTIFICATE",
            "identifier": "1715142",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stanley B Fuller Sr., L.P.N.

• Family Medicine Physician in Fremont, OH
• Providers in Fremont, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.