Provider Demographics
NPI:1487096277
Name:PARTNERS PHYSICIAN GROUP
Entity type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE REVENUE CYCLE, PPG
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-665-8332
Mailing Address - Street 1:2603 W MARKET ST
Mailing Address - Street 2:#210
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4208
Mailing Address - Country:US
Mailing Address - Phone:330-344-1382
Mailing Address - Fax:
Practice Address - Street 1:2603 W MARKET ST
Practice Address - Street 2:#210
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4208
Practice Address - Country:US
Practice Address - Phone:330-344-1382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #