=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295915569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN OHIO ARTHRITIS CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2007
-----------------------------------------------------
Last Update Date | 05/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36855 AMERICAN WAY STE A
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44011-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-934-2200
-----------------------------------------------------
Fax | 440-934-2213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36855 AMERICAN WAY STE A
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44011-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-934-2200
-----------------------------------------------------
Fax | 440-934-2213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ROBERT STEPHEN PERHALA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-934-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 35054958
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------