Healthcare Provider Details

I. General information

NPI: 1679523112
Provider Name (Legal Business Name): SYNERGY PULMONARY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 LOGAN AVE NW
CANTON OH
44709-1541
US

IV. Provider business mailing address

3750 LOGAN AVE NW
CANTON OH
44709-1541
US

V. Phone/Fax

Practice location:
  • Phone: 330-705-3318
  • Fax: 330-493-6675
Mailing address:
  • Phone: 330-705-3318
  • Fax: 330-493-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number3379
License Number StateOH

VIII. Authorized Official

Name: MS. KARLA SUE PAVELZIK
Title or Position: DIRECTOR OF SERVICES/CLINICIAN
Credential: RCP,RRT,RPFT
Phone: 330-705-3318