Healthcare Provider Details

I. General information

NPI: 1386726214
Provider Name (Legal Business Name): SUTTON INTERNAL AND PHYSICAL MEDICINE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 YOUNGSTOWN WARREN RD SUTIE 1A
NILES OH
44446-4649
US

IV. Provider business mailing address

1250 YOUNGSTOWN WARREN RD SUTIE 1A
NILES OH
44446-4649
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-1500
  • Fax: 330-544-7988
Mailing address:
  • Phone: 330-544-1500
  • Fax: 330-544-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34-00-7547-S
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34-00-7547-S
License Number StateOH

VIII. Authorized Official

Name: DR. JEFFREY BLAINE SUTTON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 330-544-1500