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General NPI Number Information
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NPI Number | 1184794885
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Entity Type | Organization
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Legal Business Name | EXECUTIVE COURT MEDICAL ASSOCIATES INC.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 54 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-9566
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Country | US
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Telephone | 419-668-5607
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Fax | 419-668-9706
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Provider Business Mailing Address
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Address Line | 54 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-9566
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Country | US
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Telephone | 419-668-5607
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Fax | 419-668-9706
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. GRAHAM M JOHNSON
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Credential | CMOM
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Telephone | 419-668-5607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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