Provider Demographics
NPI:1700397775
Name:MAGUIRE MEDICAL LLC
Entity Type:Organization
Organization Name:MAGUIRE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TAX ID OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-468-3312
Mailing Address - Street 1:2055 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1998
Mailing Address - Country:US
Mailing Address - Phone:330-468-3312
Mailing Address - Fax:330-468-0602
Practice Address - Street 1:2055 ALEXANDRIA WAY
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1998
Practice Address - Country:US
Practice Address - Phone:330-468-3312
Practice Address - Fax:330-468-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty