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 State
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	OH
2	207XX0801X	Orthopaedic Trauma Physician	OH
3	207QS0010X	Sports Medicine (Family Medicine) Physician	OH
4	213E00000X	Podiatrist
5	207XS0106X	Orthopaedic Hand Surgery Physician	OH
6	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE #

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
3	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1811936602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	43 S MAIN ST
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1635
Country	:	US
Telephone Number	:	330-344-1980
Fax Number	:	330-344-6038

Provider Business Practice Location Address
First Line	:	43 S MAIN ST
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1635
Country	:	US
Telephone Number	:	330-344-1980
Fax Number	:	330-344-6038

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER AND CONTRO
Name	:	TIMOTHY L LONGVILLE
Credential	:
Telephone Number	:	216-636-7416

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/23/2022

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