Provider Demographics
NPI:1396782876
Name:PARTNERS PHYSICIAN GROUP
Entity type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE BUSINESS OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:557 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3147
Mailing Address - Country:US
Mailing Address - Phone:330-376-4545
Mailing Address - Fax:330-376-8077
Practice Address - Street 1:557 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3147
Practice Address - Country:US
Practice Address - Phone:330-376-4545
Practice Address - Fax:330-376-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1232120005Medicare NSC