Basic Information
Provider Information
NPI: 1679845069
EntityType: 2
ReplacementNPI:  
OrganizationName: PARTNERS PHYISICIAN GROUP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: THOMPSON ORTHOPAEDICS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4125 MEDINA RD
Address2: #200C
City: AKRON
State: OH
PostalCode: 443332483
CountryCode: US
TelephoneNumber: 3303441270
FaxNumber: 3306654190
Practice Location
Address1: 4125 MEDINA RD
Address2: #200C
City: AKRON
State: OH
PostalCode: 443332483
CountryCode: US
TelephoneNumber: 3303441270
FaxNumber: 3306654190
Other Information
ProviderEnumerationDate: 02/01/2012
LastUpdateDate: 02/01/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: TAILLARD
AuthorizedOfficialFirstName: DANIEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR, FINANCE & OPERATIONS
AuthorizedOfficialTelephone: 3303446095
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X OHY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
933863501OHPARTNERS PHYSICIAN GROUP MEDICARE #OTHER
255167101OHPARTNERS PHYSICIAN GROUP MEDICAID #OTHER
184123927401OHPARTNERS PHYSICIAN GROUP NPI #OTHER


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