1649517046 NPI number — TOTAL MEDICAL CARE

Table of content: MR. SAMGELLA EDWARD BANISOBA SR. (NPI 1386452803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649517046 NPI number — TOTAL MEDICAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL MEDICAL CARE
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:
1649517046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4048 DRESSLER RD NW STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44718-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-956-6058
Provider Business Mailing Address Fax Number:
330-956-5345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4048 DRESSLER RD NW STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-2784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-956-5236
Provider Business Practice Location Address Fax Number:
330-956-5345
Provider Enumeration Date:
01/07/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAWAL
Authorized Official First Name:
ISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-754-8378

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35.088985 , 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)