Provider Demographics
NPI:1376819482
Name:1227 EAST MARKET STREET, INC.
Entity Type:Organization
Organization Name:1227 EAST MARKET STREET, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-393-1501
Mailing Address - Street 1:1227 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6605
Mailing Address - Country:US
Mailing Address - Phone:330-393-1501
Mailing Address - Fax:330-394-4539
Practice Address - Street 1:1227 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6605
Practice Address - Country:US
Practice Address - Phone:330-393-1501
Practice Address - Fax:330-394-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Single Specialty