Provider Demographics
NPI:1164530234
Name:DOCTORS PRIMARY CARE - MILL RUN, INC.
Entity Type:Organization
Organization Name:DOCTORS PRIMARY CARE - MILL RUN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAVELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-218-9413
Mailing Address - Street 1:PO BOX 73784
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:727-287-6300
Mailing Address - Fax:727-287-6305
Practice Address - Street 1:3535 FISHINGER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7504
Practice Address - Country:US
Practice Address - Phone:614-777-9250
Practice Address - Fax:614-777-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2637034Medicaid
OH9359001Medicare ID - Type UnspecifiedGROUP NUMBER