1740339431 NPI number — AULTMAN NORTH CANTON MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740339431 NPI number — AULTMAN NORTH CANTON MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AULTMAN NORTH CANTON MEDICAL 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:
NORTH CANTON MEDICAL FOUNDATION
Provider Other Organization Name Type Code:
4
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:
1740339431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6046 WHIPPLE AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44720-7616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-433-1424
Provider Business Mailing Address Fax Number:
330-305-5047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6046 WHIPPLE AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44720-7616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-433-1200
Provider Business Practice Location Address Fax Number:
330-305-5047
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOLNAR
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
330-363-1226

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HMER.22838 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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