Provider Demographics
NPI:1912279399
Name:PRACTICE MANAGEMENT ASSOCIATES NORWALK LLC
Entity Type:Organization
Organization Name:PRACTICE MANAGEMENT ASSOCIATES NORWALK LLC
Other - Org Name:AMC OF NORWALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HRADEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-245-4444
Mailing Address - Street 1:32 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:567-245-4444
Mailing Address - Fax:567-245-4441
Practice Address - Street 1:32 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:567-245-4444
Practice Address - Fax:567-245-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty