Provider Demographics
NPI:1164664124
Name:GEORGE PAPACOSTAS, LLC
Entity Type:Organization
Organization Name:GEORGE PAPACOSTAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPACOSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-495-5719
Mailing Address - Street 1:3206 20TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2918
Mailing Address - Country:US
Mailing Address - Phone:330-495-5719
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH STREET SW
Practice Address - Street 2:AULTMAN WOUND CARE CENTER
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-4977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084670282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491898Medicaid
OH2491898Medicaid