MEDICARE: PPC-DDM LLC

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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1295014413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PPC-DDM LLC

Provider Business Mailing Address
First Line	:	211 COMMERCE DR
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-1331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8191 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2023
Country	:	US
Telephone Number	:	440-743-2273
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VP/CFO
Name	:	MR. BARRY FRANKLIN
Credential	:
Telephone Number	:	440-743-4230

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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