Healthcare Provider Details

I. General information

NPI: 1770757262
Provider Name (Legal Business Name): PRIMARY HEALTHCARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 YOUNGSTOWN WARREN RD
NILES OH
44446-4356
US

IV. Provider business mailing address

690 YOUNGSTOWN WARREN RD
NILES OH
44446-4356
US

V. Phone/Fax

Practice location:
  • Phone: 330-652-1776
  • Fax:
Mailing address:
  • Phone: 330-652-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number34005000C
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number34005000C
License Number StateOH

VIII. Authorized Official

Name: DR. PAUL MICHAEL CAYAVEC
Title or Position: PRESIDENT
Credential: D.O.,
Phone: 330-652-1776