1275703506 NPI number — PARTNERS PHYSICIAN GROUP

Table of content: (NPI 1275703506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275703506 NPI number — PARTNERS PHYSICIAN GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS PHYSICIAN GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275703506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3428 W MARKET ST
Provider Second Line Business Mailing Address:
#103
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-344-3583
Provider Business Mailing Address Fax Number:
330-869-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GREENWICH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-825-7371
Provider Business Practice Location Address Fax Number:
330-825-7473
Provider Enumeration Date:
03/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAILLARD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR,FINANCE BUSINESS OPERATION
Authorized Official Telephone Number:
330-344-6095

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)