Provider Demographics
NPI:1336479401
Name:HEALTH FIRST PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HEALTH FIRST PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-312-1969
Mailing Address - Street 1:9313 LARIMAR DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-5249
Mailing Address - Country:US
Mailing Address - Phone:216-862-8063
Mailing Address - Fax:
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:STE 336
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2270
Practice Address - Country:US
Practice Address - Phone:440-312-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3037449Medicaid
OH9387841Medicare PIN