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
1	207Q00000X	Family Medicine Physician	35-075449	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP NPI GROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932400272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	231 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8864
Country	:	US
Telephone Number	:	330-769-4695
Fax Number	:	330-769-4936

Provider Business Practice Location Address
First Line	:	231 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8864
Country	:	US
Telephone Number	:	330-769-4695
Fax Number	:	330-769-4936

Authorized Official
Title or Position	:	DIRECTOR, FINANCE
Name	:	DANIEL TAILLARD
Credential	:
Telephone Number	:	330-344-6095

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	12/07/2010

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Directions to “PARTNERS PHYSICIAN GROUP ” Practice Location

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