Healthcare Provider Details

I. General information

NPI: 1174610398
Provider Name (Legal Business Name): STARK COUNTY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 MUNSON ST NW
CANTON OH
44718-3613
US

IV. Provider business mailing address

4810 MUNSON ST NW
CANTON OH
44718-3613
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-3377
  • Fax: 330-499-3999
Mailing address:
  • Phone: 330-499-3377
  • Fax: 330-499-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35076280B
License Number StateOH

VIII. Authorized Official

Name: DR. BARBARA H VOLK
Title or Position: OWNER
Credential: M.D.
Phone: 330-499-3377