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General NPI Number Information
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NPI Number | 1104864578
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Entity Type | Organization
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Legal Business Name | PARTNERS PHYSICIAN GROUP
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 4125 MEDINA RD
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City | AKRON
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State | OH
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Zip | 44333-2483
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Country | US
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Telephone | 330-344-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 4125 MEDINA RD
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City | AKRON
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State | OH
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Zip | 44333-2483
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER AND CONTRO
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Name | TIMOTHY L LONGVILLE
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Credential |
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Telephone | 216-636-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | OH
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