Provider Demographics
NPI:1699362863
Name:AZIMUTH MEDICAL LLC
Entity Type:Organization
Organization Name:AZIMUTH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:440-391-1308
Mailing Address - Street 1:1701 MENTOR AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1459
Mailing Address - Country:US
Mailing Address - Phone:440-391-1308
Mailing Address - Fax:
Practice Address - Street 1:1701 MENTOR AVE STE 10
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1459
Practice Address - Country:US
Practice Address - Phone:440-391-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service