Healthcare Provider Details

I. General information

NPI: 1649383340
Provider Name (Legal Business Name): NORTH CANTON MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6513 FRANK AVE NW
NORTH CANTON OH
44720-7265
US

IV. Provider business mailing address

6046 WHIPPLE AVE NW
NORTH CANTON OH
44720-7616
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-1300
  • Fax: 330-494-0828
Mailing address:
  • Phone: 330-433-1200
  • Fax: 330-305-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY J. MURPHY
Title or Position: CFO
Credential:
Phone: 330-433-1400