Healthcare Provider Details

I. General information

NPI: 1417102641
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ARLINGTON ST #38
AKRON OH
44306-3750
US

IV. Provider business mailing address

PO BOX 715146
COLUMBUS OH
43271-5146
US

V. Phone/Fax

Practice location:
  • Phone: 330-724-5471
  • Fax: 330-786-0108
Mailing address:
  • Phone: 330-576-0200
  • Fax: 330-576-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL TAILLARD
Title or Position: DIRECTOR, FINANCE & OPERATIONS
Credential:
Phone: 330-344-6095