Provider Demographics
NPI:1750314639
Name:AKRON GENERAL MEDICAL CENTER INTERNAL MEDICINE CENTER OF AKRON
Entity Type:Organization
Organization Name:AKRON GENERAL MEDICAL CENTER INTERNAL MEDICINE CENTER OF AKRON
Other - Org Name:INTERNAL MEDICINE CENTER OF AKRON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - PHYSICIAN PRACTICE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-4004
Mailing Address - Street 1:400 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2433
Mailing Address - Country:US
Mailing Address - Phone:330-344-6015
Mailing Address - Fax:330-344-6820
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:5TH FLOOR, BUILDING 301
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6015
Practice Address - Fax:330-344-6820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GENERAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH045477Medicaid
OH045477Medicaid