Provider Demographics
NPI:1811172778
Name:NORTH CHAGRIN SPORTS MEDICINE
Entity type:Organization
Organization Name:NORTH CHAGRIN SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:REX-TORZOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-944-5700
Mailing Address - Street 1:842 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1537
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:34820 CHARDON RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9103
Practice Address - Country:US
Practice Address - Phone:440-944-5700
Practice Address - Fax:440-944-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007880R207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNO9355371Medicare PIN