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General NPI Number Information
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NPI Number | 1427068634
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Entity Type | Organization
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Legal Business Name | STARK COUNTY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 4810 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3613
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Country | US
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Telephone | 330-499-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARRIE LYNN GILLSON
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Credential |
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Telephone | 330-499-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01397525
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01397525
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License Number State | OH
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