MEDICARE: PARAGON HEALTH ASSOCIATES, 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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1578515615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAGON HEALTH ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1 PARK WEST BLVD
Second Line	:	SUITE 200
City	:	AKRON
State	:	OH
Zip	:	44320-4218
Country	:	US
Telephone Number	:	330-869-9777
Fax Number	:	330-869-0052

Provider Business Practice Location Address
First Line	:	1463 CANTON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-4022
Country	:	US
Telephone Number	:	330-784-5406
Fax Number	:	330-784-3654

Authorized Official
Title or Position	:	MEDICAL CREDENTIALING CONSULTANT
Name	:	MRS. MELANIE L MICK
Credential	:
Telephone Number	:	234-855-6458

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/05/2013

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