Provider Demographics
NPI:1669581799
Name:JOHN T GIVEN MD INC
Entity type:Organization
Organization Name:JOHN T GIVEN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-479-3333
Mailing Address - Street 1:4048 DRESSLER RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2784
Mailing Address - Country:US
Mailing Address - Phone:330-479-3333
Mailing Address - Fax:330-479-3334
Practice Address - Street 1:4048 DRESSLER RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-479-3333
Practice Address - Fax:330-479-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050329207RP1001X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0563439Medicaid
OH0264922Medicaid
OHC03768Medicare UPIN
OHJO09332571Medicare ID - Type UnspecifiedGROUP NUMBER
OHGI0549015Medicare PIN