Provider Demographics
NPI:1285696732
Name:FERNANDEZ RENNER & SCAI
Entity type:Organization
Organization Name:FERNANDEZ RENNER & SCAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-492-1222
Mailing Address - Street 1:3244 BAILEY ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3616
Mailing Address - Country:US
Mailing Address - Phone:330-833-3110
Mailing Address - Fax:330-833-3115
Practice Address - Street 1:3244 BAILEY ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3616
Practice Address - Country:US
Practice Address - Phone:330-833-3110
Practice Address - Fax:330-833-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843043Medicaid
OHCM0529OtherMEDICARE ID TYPE UNSPEC
OH9267133Medicare PIN