Provider Demographics
NPI:1295847960
Name:NORTH EAST OHIO MEDICAL CARE
Entity Type:Organization
Organization Name:NORTH EAST OHIO MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-399-2500
Mailing Address - Street 1:8528 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2343
Mailing Address - Country:US
Mailing Address - Phone:330-399-2500
Mailing Address - Fax:330-399-2513
Practice Address - Street 1:8528 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2343
Practice Address - Country:US
Practice Address - Phone:330-399-2500
Practice Address - Fax:330-399-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1295847960Medicaid
OH876891Medicare UPIN
OH871045Medicare UPIN