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General NPI Number Information
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NPI Number | 1639361074
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Entity Type | Organization
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Legal Business Name | MARYMOUNT PRIMARY CARE SERVICES, INC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 12000 MCCRACKEN RD SUITE 450
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2964
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Country | US
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Telephone | 216-663-7355
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Fax | 216-663-7193
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Provider Business Mailing Address
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Address Line | 12000 MCCRACKEN RD SUITE 450
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2964
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Country | US
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Telephone | 216-663-7355
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Fax | 216-663-7193
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PETER P WALCHANOWICZ
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Credential |
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Telephone | 440-543-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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