Provider Demographics
NPI:1093889420
Name:POLARIS MEDICAL CARE
Entity Type:Organization
Organization Name:POLARIS MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOSKOBNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-880-9540
Mailing Address - Street 1:1327 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9662
Mailing Address - Country:US
Mailing Address - Phone:614-880-9540
Mailing Address - Fax:614-410-1066
Practice Address - Street 1:1327 CAMERON AVE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9662
Practice Address - Country:US
Practice Address - Phone:614-880-9540
Practice Address - Fax:614-410-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9317931Medicare ID - Type Unspecified