Provider Demographics
NPI:1699905851
Name:PHYSICIAN'S MEDICAL CENTER INC
Entity type:Organization
Organization Name:PHYSICIAN'S MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-856-9494
Mailing Address - Street 1:369 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2430
Mailing Address - Country:US
Mailing Address - Phone:330-856-9494
Mailing Address - Fax:330-856-1038
Practice Address - Street 1:369 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2430
Practice Address - Country:US
Practice Address - Phone:330-856-9494
Practice Address - Fax:330-856-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007714208D00000X
OHPT 012820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty