Provider Demographics
NPI:1770896268
Name:PARTNERS PHYSICIAN GROUP
Entity type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER, PPG
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-665-8302
Mailing Address - Street 1:33 NORTH AVE
Mailing Address - Street 2:#104
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1925
Mailing Address - Country:US
Mailing Address - Phone:330-344-3990
Mailing Address - Fax:330-634-9433
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:#104
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-344-3990
Practice Address - Fax:330-634-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1992138028OtherPARTNERS PHYSICIAN GROUP AKRON GENERAL URGENT CARE TYPE 2 NPI #
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI GROUP #