Provider Demographics
NPI:1164814414
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:COMMUNITY ACCESS AND WELLNESS - HWE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, MANAGED CARE DEPT.
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ICSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-1657
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-344-4287
Mailing Address - Fax:
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-344-4287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GENERAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-24
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2083P0901X, 363LC1500X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #