Healthcare Provider Details

I. General information

NPI: 1972555944
Provider Name (Legal Business Name): MVES AUSTINTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6252 MAHONING AVE
AUSTINTOWN OH
44515-2003
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4019
  • Fax:
Mailing address:
  • Phone: 330-994-4409
  • Fax: 330-492-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA REESE
Title or Position: PROVIDER ENROLLMENT OFFICER
Credential:
Phone: 855-687-0618