1780857151 NPI number — PARTNERS PHYSICIAN GROUP

Table of content: (NPI 1780857151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780857151 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:
6
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:
1780857151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4302 ALLEN RD
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-344-7820
Provider Business Mailing Address Fax Number:
330-928-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 ALLEN RD
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-1070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-344-7820
Provider Business Practice Location Address Fax Number:
330-928-4320
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRAMAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER, PPG
Authorized Official Telephone Number:
330-665-8302

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , 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)

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




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