Provider Demographics
NPI: | 1841239274 |
---|---|
Name: | PARTNERS PHYSICIAN GROUP |
Entity Type: | Organization |
Organization Name: | PARTNERS PHYSICIAN GROUP |
Other - Org Name: | NETWORK HEALTH GROUP |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | CHIEF ACCOUNTING OFFICER AND CONTRO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIMOTHY |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | LONGVILLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-636-7416 |
Mailing Address - Street 1: | 1 AKRON GENERAL AVE |
Mailing Address - Street 2: | BELLOWS BLDG. |
Mailing Address - City: | AKRON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44307-2432 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-344-3583 |
Mailing Address - Fax: | 330-344-2930 |
Practice Address - Street 1: | 224 W EXCHANGE ST |
Practice Address - Street 2: | |
Practice Address - City: | AKRON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44302-1704 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-344-3583 |
Practice Address - Fax: | 330-344-2930 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | AKRON GENERAL MEDICAL CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-06-04 |
Last Update Date: | 2022-02-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 207Q00000X, 207R00000X, 207RH0003X, 207VG0400X, 208100000X, 2084P0800X, 208600000X, 2086S0129X | |
207QS0010X, 207RC0000X, 207RE0101X, 207RR0500X, 207X00000X, 208G00000X, 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2551671 | Medicaid | |
OH | 9338635 | Medicare PIN | |
OH | 1232120018 | Medicare NSC |