Healthcare Provider Details

I. General information

NPI: 1992914923
Provider Name (Legal Business Name): MEDICAL RESOURCE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26016 DETROIT RD STE 5
WESTLAKE OH
44145-2453
US

IV. Provider business mailing address

26016 DETROIT RD STE 5
WESTLAKE OH
44145-2453
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-0424
  • Fax: 440-250-0429
Mailing address:
  • Phone: 440-250-0424
  • Fax: 440-250-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE A PANSTARES
Title or Position: PRESIDENT
Credential:
Phone: 440-250-0424