Healthcare Provider Details

I. General information

NPI: 1013034206
Provider Name (Legal Business Name): PEDIATRIC AND FAMILY MEDICINE HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 WALES AVE NW SUITE C & D
MASSILLON OH
44646-0804
US

IV. Provider business mailing address

2400 WALES AVE NW SUITE C & D
MASSILLON OH
44646-0804
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-4467
  • Fax: 330-837-4688
Mailing address:
  • Phone: 330-837-4467
  • Fax: 330-837-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number35-100320
License Number StateOH

VIII. Authorized Official

Name: DR. DELIA SLAGA
Title or Position: OWNER
Credential: MD
Phone: 330-837-4467