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General NPI Number Information
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NPI Number | 1164664124
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Entity Type | Organization
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Legal Business Name | GEORGE PAPACOSTAS, LLC
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 2600 6TH STREET SW AULTMAN WOUND CARE CENTER
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City | CANTON
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State | OH
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Zip | 44710
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Country | US
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Telephone | 330-363-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 20TH ST NW
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City | CANTON
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State | OH
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Zip | 44708-2918
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Country | US
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Telephone | 330-495-5719
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE PAPACOSTAS
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Credential | MD
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Telephone | 330-495-5719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 35084670
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License Number State | OH
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