Provider Demographics
NPI:1528245479
Name:PURA G VARGAS MD INC
Entity type:Organization
Organization Name:PURA G VARGAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-668-8881
Mailing Address - Street 1:38 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:419-668-8881
Mailing Address - Fax:419-668-0668
Practice Address - Street 1:38 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:419-668-8881
Practice Address - Fax:419-668-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032040207LP2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144356Medicaid
OH000000128808OtherANTHEM BCBS
OH024328291001OtherMEDICAL MUTUAL
OH9176482Medicare PIN
OH000000128808OtherANTHEM BCBS