Healthcare Provider Details

I. General information

NPI: 1316535974
Provider Name (Legal Business Name): 1419 ARLINGTON MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 S ARLINGTON ST
AKRON OH
44306
US

IV. Provider business mailing address

1712 PIONEER AVE STE 500
CHEYENNE WY
82001
US

V. Phone/Fax

Practice location:
  • Phone: 330-773-3882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: REBECCA MURRAY
Title or Position: REPRESENTATTIVE
Credential:
Phone: 615-613-3871