Provider Demographics
NPI:1336331347
Name:D AMICO PATCHEN SURGERY INC
Entity Type:Organization
Organization Name:D AMICO PATCHEN SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNODEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-856-6201
Mailing Address - Street 1:8601 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2347
Mailing Address - Country:US
Mailing Address - Phone:330-856-6201
Mailing Address - Fax:330-856-6349
Practice Address - Street 1:8601 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2347
Practice Address - Country:US
Practice Address - Phone:330-856-6201
Practice Address - Fax:330-856-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0976556Medicaid
OH9269411Medicare PIN