1821342643 NPI number — PARTNERS PHYSICIAN GROUP

Table of content: (NPI 1821342643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821342643 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:
BRANDON D. WEEKS, MD
Provider Other Organization Name Type Code:
3
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:
1821342643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 TALLMADGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44221-3362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-436-6890
Provider Business Mailing Address Fax Number:
330-475-7544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 TALLMADGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUYAHOGA FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44221-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-436-6890
Provider Business Practice Location Address Fax Number:
330-475-7544
Provider Enumeration Date:
10/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP, PHYSICIAN PRACTICE SERVICES
Authorized Official Telephone Number:
330-665-8331

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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