Provider Demographics
NPI:1588839617
Name:KENT MANAGEMENT GROUP
Entity Type:Organization
Organization Name:KENT MANAGEMENT GROUP
Other - Org Name:PREMIERE MEDICAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-929-2685
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-0609
Mailing Address - Country:US
Mailing Address - Phone:330-923-6606
Mailing Address - Fax:330-923-8090
Practice Address - Street 1:999 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1456
Practice Address - Country:US
Practice Address - Phone:330-929-2694
Practice Address - Fax:330-929-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5777020004Medicare NSC