Provider Demographics
NPI:1043511595
Name:PARTNERS PHYSICIAN GROUP
Entity type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:#305
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-7400
Mailing Address - Fax:330-344-2015
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:#305
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-7400
Practice Address - Fax:330-344-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338632OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #