Provider Demographics
NPI:1922285063
Name:LA SALETTE PERSONAL PRIMARY HEALTH CARE LLC
Entity Type:Organization
Organization Name:LA SALETTE PERSONAL PRIMARY HEALTH CARE LLC
Other - Org Name:MARGARITA M LASSALETTA DBA LA SALETTE PPHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSALETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-336-5046
Mailing Address - Street 1:185 WADSWORTH RD
Mailing Address - Street 2:2E
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8330
Mailing Address - Country:US
Mailing Address - Phone:330-336-5046
Mailing Address - Fax:330-336-5052
Practice Address - Street 1:185 WADSWORTH RD
Practice Address - Street 2:2E
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8330
Practice Address - Country:US
Practice Address - Phone:330-336-5046
Practice Address - Fax:330-336-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067706L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5908582OtherAETNA
00000309393OtherABCBS
OH2045085Medicaid
OH5908582OtherAETNA