Healthcare Provider Details

I. General information

NPI: 1235439787
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALLEN RD
STOW OH
44224-1070
US

IV. Provider business mailing address

4302 ALLEN RD
STOW OH
44224-1070
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1980
  • Fax: 330-344-6038
Mailing address:
  • Phone: 330-344-1980
  • Fax: 330-344-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateOH

VIII. Authorized Official

Name: TIMOTHY L LONGVILLE
Title or Position: CHIEF ACCOUNTING OFFICER AND CONTRO
Credential:
Phone: 216-636-7416