Provider Demographics
NPI:1922110642
Name:ST MARYS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:ST MARYS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGUIRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-394-5851
Mailing Address - Street 1:1132 HAGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2423
Mailing Address - Country:US
Mailing Address - Phone:419-394-5851
Mailing Address - Fax:419-394-0702
Practice Address - Street 1:1132 HAGER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2423
Practice Address - Country:US
Practice Address - Phone:419-394-5851
Practice Address - Fax:419-394-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-032121P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4466481OtherAETNA
OH000000127763OtherANTHEM
OH0333535Medicaid
OH000000127763OtherANTHEM
OH=========-00OtherWORKERS COMP