Provider Demographics
NPI:1376779702
Name:ACUTE CARE SURGERY SERVICE AT AKRON
Entity Type:Organization
Organization Name:ACUTE CARE SURGERY SERVICE AT AKRON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER AND CONTRO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-444-2296
Mailing Address - Street 1:1 AKRON GENERAL AVE
Mailing Address - Street 2:ATTN DOREEN MEREDITH
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2432
Mailing Address - Country:US
Mailing Address - Phone:330-344-5056
Mailing Address - Fax:330-344-2930
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:ACC. BLDG.
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-5180
Practice Address - Fax:330-344-5669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GENERAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3010904Medicaid
OH3010904Medicaid