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General NPI Number Information
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NPI Number | 1417772849
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Entity Type | Organization
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Legal Business Name | BEACON PRIMARY CARE LLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3009 SMITH RD STE 350
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City | FAIRLAWN
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State | OH
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Zip | 44333-2670
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Country | US
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Telephone | 330-665-4488
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Fax | 330-665-4489
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Provider Business Mailing Address
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Address Line | 3009 SMITH RD STE 350
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City | FAIRLAWN
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State | OH
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Zip | 44333-2670
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Country | US
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Telephone | 330-665-4488
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Fax | 330-665-4489
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JENNIFER L WURST
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Credential | MD
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Telephone | 216-224-3052
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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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