Provider Demographics
NPI:1437203478
Name:CHRISTOPHER G. ECONOMUS, D.O.,LLC
Entity Type:Organization
Organization Name:CHRISTOPHER G. ECONOMUS, D.O.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ECONOMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-533-2218
Mailing Address - Street 1:61 TALSMAN DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1207
Mailing Address - Country:US
Mailing Address - Phone:330-533-2218
Mailing Address - Fax:330-533-6111
Practice Address - Street 1:61 TALSMAN DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1207
Practice Address - Country:US
Practice Address - Phone:330-533-2218
Practice Address - Fax:330-533-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6797-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP02131Medicare PIN