Doctors Family Practice Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

OH6079 Issued in OH

Legal business name

DOCTORS FAMILY PRACTICE GROUP

Practice address

6543 E Main St
Suite C
Reynoldsburg, OH 43068-2429

Phone

(614) 322-6063

Fax

(614) 322-9710

NPI assigned

Dec 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Benedicta O Udeagbala, D.O.

Title

Medical Director

Phone

(614) 322-6063

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329436800000",
    "number": "1649453754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 785",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430680785",
            "telephone_number": "614-322-6063",
            "fax_number": "614-322-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6543 E MAIN ST",
            "address_2": "SUITE C",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430682429",
            "telephone_number": "614-322-6063",
            "fax_number": "614-322-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS FAMILY PRACTICE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2012-02-17",
        "status": "A",
        "authorized_official_last_name": "UDEAGBALA",
        "authorized_official_first_name": "BENEDICTA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "614-322-6063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OH",
            "license": "OH6079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0241812",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Reynoldsburg, OH
• Providers in Reynoldsburg, OH by specialty
• Primary Care Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; 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.