Basic Information
Provider Information
NPI: 1235234196
EntityType: 2
ReplacementNPI:  
OrganizationName: NORTH CANTON FAMILY PHYSICIANS INC
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Mailing Information
Address1: PO BOX 80690
Address2:  
City: CANTON
State: OH
PostalCode: 44708
CountryCode: US
TelephoneNumber: 3308335530
FaxNumber: 3308336085
Practice Location
Address1: 133 WILBUR DR NE
Address2:  
City: NORTH CANTON
State: OH
PostalCode: 44720
CountryCode: US
TelephoneNumber: 3304946012
FaxNumber: 3304940403
Other Information
ProviderEnumerationDate: 09/14/2006
LastUpdateDate: 08/22/2020
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AuthorizedOfficialLastName: JENRETTE
AuthorizedOfficialFirstName: MARILYN
AuthorizedOfficialMiddleName: SPRAGG
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3304946012
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
070188805OH MEDICAID


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