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General NPI Number Information
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NPI Number | 1194778522
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Entity Type | Organization
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Legal Business Name | PORTAGE SURGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3973 LOOMIS PKWY SUITE B
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City | RAVENNA
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State | OH
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Zip | 44266-1803
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Country | US
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Telephone | 330-296-8239
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Fax | 330-296-6528
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Provider Business Mailing Address
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Address Line | 3973 LOOMIS PKWY SUITE B
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City | RAVENNA
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State | OH
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Zip | 44266-1803
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Country | US
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Telephone | 330-296-8239
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Fax | 330-296-6528
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD PANZETER
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Credential | MD
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Telephone | 330-296-8239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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