Provider Demographics
NPI:1194725259
Name:YOUNGSTOWN INTERNAL MEDICINE, L.L.C.
Entity type:Organization
Organization Name:YOUNGSTOWN INTERNAL MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNARRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-743-6270
Mailing Address - Street 1:550 PARMALEE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1602
Mailing Address - Country:US
Mailing Address - Phone:333-074-3627
Mailing Address - Fax:330-743-6596
Practice Address - Street 1:550 PARMALEE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1602
Practice Address - Country:US
Practice Address - Phone:333-074-3627
Practice Address - Fax:330-743-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7163-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9342371Medicare ID - Type Unspecified