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NPI Code Detail

MEDICARE: PARTNERS PHYSICIAN GROUP

MEDICARE: PARTNERS PHYSICIAN GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21841239274OTHEROHMEDICARE GROUP NPI #
39338635OTHEROHMEDICARE GROUP #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083864144
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARTNERS PHYSICIAN GROUP
Provider Business Mailing Address
First Line : 754 S CLEVELAND AVE
Second Line :
City : MOGADORE
State : OH
Zip : 44260-2210
Country : US
Telephone Number : 330-628-2686
Fax Number : 330-628-0828
Provider Business Practice Location Address
First Line : 754 S CLEVELAND AVE
Second Line :
City : MOGADORE
State : OH
Zip : 44260-2210
Country : US
Telephone Number : 330-628-2686
Fax Number : 330-628-0828
Authorized Official
Title or Position : DIRECTOR, FINANCE
Name : DANIEL TAILLARD
Credential :
Telephone Number : 330-344-6095
Provider Enumeration Date : 09/25/2008
Last Update Date : 07/01/2011

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Directions to “PARTNERS PHYSICIAN GROUP ” Practice Location

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