Healthcare Provider Details

I. General information

NPI: 1679826010
Provider Name (Legal Business Name): STARK COUNTY EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5154 FULTON DR NW
CANTON OH
44718-2365
US

IV. Provider business mailing address

5154 FULTON DR NW
CANTON OH
44718-2365
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-8837
  • Fax:
Mailing address:
  • Phone: 330-499-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number363A00000X
License Number StateOH

VIII. Authorized Official

Name: DR. FRANK KAEBERLEIN
Title or Position: MD, VICE PRESIDENT
Credential:
Phone: 330-489-1365