Provider Demographics
NPI:1417192642
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:SUMMIT ADULT MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:3600 W MARKET ST
Mailing Address - Street 2:#200
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4540
Mailing Address - Country:US
Mailing Address - Phone:330-666-2700
Mailing Address - Fax:330-666-0500
Practice Address - Street 1:3600 W MARKET ST
Practice Address - Street 2:#200
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4540
Practice Address - Country:US
Practice Address - Phone:330-666-2700
Practice Address - Fax:330-666-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherMEDICARE NPI GROUP #
OH0952698Medicaid
OH9338635Medicare PIN