Provider Demographics
NPI:1962587097
Name:PHYSICIANS FIRST INC.
Entity type:Organization
Organization Name:PHYSICIANS FIRST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUST
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-461-4848
Mailing Address - Street 1:1438 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2111
Mailing Address - Country:US
Mailing Address - Phone:440-461-4848
Mailing Address - Fax:440-461-5548
Practice Address - Street 1:1438 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2111
Practice Address - Country:US
Practice Address - Phone:440-461-4848
Practice Address - Fax:440-461-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-9102-L208D00000X
OHPT7422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPH9288141Medicare ID - Type Unspecified