Provider Demographics
NPI:1659676518
Name:PHOENIX INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:PHOENIX INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-593-7360
Mailing Address - Street 1:224 PARRISH RD.
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2349
Mailing Address - Country:US
Mailing Address - Phone:440-593-7360
Mailing Address - Fax:440-593-6407
Practice Address - Street 1:224 PARRISH RD.
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2349
Practice Address - Country:US
Practice Address - Phone:440-593-7360
Practice Address - Fax:440-593-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007472H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty