Provider Demographics
NPI:1528007309
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:NETWORK HEALTH GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-2131
Mailing Address - Street 1:3428 W MARKET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3339
Mailing Address - Country:US
Mailing Address - Phone:330-344-4033
Mailing Address - Fax:330-896-8018
Practice Address - Street 1:140 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9503
Practice Address - Country:US
Practice Address - Phone:330-334-2555
Practice Address - Fax:330-334-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551680Medicaid
OH9338631Medicare PIN