Provider Demographics
NPI:1295227486
Name:CENTRAL OHIO VALLEY PRACTITIONERS LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO VALLEY PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-842-8675
Mailing Address - Street 1:30701 LORAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:6681 RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5705
Practice Address - Country:US
Practice Address - Phone:440-842-8675
Practice Address - Fax:440-842-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34006341OtherOHIO MEDICAL BOARD