Provider Demographics
NPI:1467659417
Name:ALLEN COUNTY CARDIOLOGY
Entity Type:Organization
Organization Name:ALLEN COUNTY CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-222-7350
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1669
Mailing Address - Country:US
Mailing Address - Phone:419-222-7350
Mailing Address - Fax:
Practice Address - Street 1:635 W SPRING ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4643
Practice Address - Country:US
Practice Address - Phone:419-222-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-051486207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618068Medicaid
OH2210502Medicaid
OH0807875Medicare ID - Type UnspecifiedDR PERONA PIN
OH9312151Medicare PIN
OH1346296399Medicare ID - Type UnspecifiedDR PERONA NPI
OH2210502Medicaid