MEDICARE: PARTNERS PHYSICIAN GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician		OH
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician		OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1033476908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	754 S CLEVELAND AVE
Second Line	:	#301
City	:	MOGADORE
State	:	OH
Zip	:	44260-2210
Country	:	US
Telephone Number	:	330-344-1980
Fax Number	:	330-344-6038

Provider Business Practice Location Address
First Line	:	754 S CLEVELAND AVE
Second Line	:	#301
City	:	MOGADORE
State	:	OH
Zip	:	44260-2210
Country	:	US
Telephone Number	:	330-344-1980
Fax Number	:	330-344-6038

Authorized Official
Title or Position	:	VP, FINANCE
Name	:	DANIEL TAILLARD
Credential	:
Telephone Number	:	330-344-6095

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	04/17/2012

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Directions to “PARTNERS PHYSICIAN GROUP ” Practice Location

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