Provider Demographics
NPI:1619156866
Name:EDWARD G MYERS DO INC
Entity Type:Organization
Organization Name:EDWARD G MYERS DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-372-5200
Mailing Address - Street 1:2581 NORTH RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3052
Mailing Address - Country:US
Mailing Address - Phone:330-372-5200
Mailing Address - Fax:330-372-4437
Practice Address - Street 1:2581 NORTH RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3052
Practice Address - Country:US
Practice Address - Phone:330-372-5200
Practice Address - Fax:330-372-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000138346OtherANTHEM
OH0757426Medicaid
OH0684812Medicare PIN
OH9317521Medicare PIN