Healthcare Provider Details

I. General information

NPI: 1083864144
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S CLEVELAND AVE
MOGADORE OH
44260-2210
US

IV. Provider business mailing address

754 S CLEVELAND AVE
MOGADORE OH
44260-2210
US

V. Phone/Fax

Practice location:
  • Phone: 330-628-2686
  • Fax: 330-628-0828
Mailing address:
  • Phone: 330-628-2686
  • Fax: 330-628-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL TAILLARD
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 330-344-6095