Provider Demographics
NPI:1710083332
Name:ARTHRITIS CLINIC OF STARK COUNTY INC.
Entity Type:Organization
Organization Name:ARTHRITIS CLINIC OF STARK COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALLERNEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-492-4966
Mailing Address - Street 1:4160 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2532
Mailing Address - Country:US
Mailing Address - Phone:330-492-4966
Mailing Address - Fax:330-429-9344
Practice Address - Street 1:4160 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2532
Practice Address - Country:US
Practice Address - Phone:330-492-4966
Practice Address - Fax:330-429-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576747Medicaid
OH0576747Medicaid