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General NPI Number Information
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NPI Number | 1619674637
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Entity Type | Organization
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Legal Business Name | STAR PEDIATRIC CARE
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 128 WERTZ AVE NW STE A
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City | CANTON
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State | OH
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Zip | 44708-4196
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Country | US
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Telephone | 330-621-0553
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Fax | 234-444-5387
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Provider Business Mailing Address
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Address Line | 128 WERTZ AVE NW STE A
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City | CANTON
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State | OH
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Zip | 44708-4196
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Country | US
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Telephone | 330-621-0553
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | MS. ASIA ANNETTE EVERETT
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Credential |
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Telephone | 330-209-9945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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