Provider Demographics
NPI:1336256247
Name:COMPREHENSIVE INTERNAL MEDICINE, INC
Entity type:Organization
Organization Name:COMPREHENSIVE INTERNAL MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-202-3444
Mailing Address - Street 1:3727 FRIENDSVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7131
Mailing Address - Country:US
Mailing Address - Phone:330-202-3444
Mailing Address - Fax:330-202-3435
Practice Address - Street 1:3727 FRIENDSVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7131
Practice Address - Country:US
Practice Address - Phone:330-202-3444
Practice Address - Fax:330-202-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145486Medicaid
OH2145486Medicaid