Provider Demographics
NPI:1871578229
Name:SUMMIT COUNTY INTENSIVE CARE PHYSICIANS INC
Entity type:Organization
Organization Name:SUMMIT COUNTY INTENSIVE CARE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP FACPE
Authorized Official - Phone:330-375-3588
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-3588
Mailing Address - Fax:330-375-7615
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:SUITE 1N
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3588
Practice Address - Fax:330-375-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0702967Medicaid
OHSU9926691Medicare ID - Type Unspecified