Provider Demographics
NPI:1316013550
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:WADSWORTH RITTMAN AREA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KONTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-336-3583
Mailing Address - Street 1:323 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1869
Mailing Address - Country:US
Mailing Address - Phone:330-336-3583
Mailing Address - Fax:330-334-1448
Practice Address - Street 1:323 HIGH ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1869
Practice Address - Country:US
Practice Address - Phone:330-336-3583
Practice Address - Fax:330-334-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0713786Medicaid
OH0713786Medicaid