Provider Demographics
NPI: | 1013223312 |
---|---|
Name: | YOUNGSTOWN OHIO PHYSICIAN SERVICES COMPANY LLC |
Entity Type: | Organization |
Organization Name: | YOUNGSTOWN OHIO PHYSICIAN SERVICES COMPANY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SR. DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | WRIGHT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-465-7587 |
Mailing Address - Street 1: | PO BOX 689022 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37068-9022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-628-6038 |
Mailing Address - Fax: | 615-465-3007 |
Practice Address - Street 1: | 500 GYPSY LN |
Practice Address - Street 2: | |
Practice Address - City: | YOUNGSTOWN |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44504-1315 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-884-0120 |
Practice Address - Fax: | 330-884-0175 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-08-24 |
Last Update Date: | 2014-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 3099150 | Medicaid | |
OH | 3099150 | Medicaid |