Basic Information
Provider Information | |||||||||
NPI: | 1831142140 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCINTYRE | ||||||||
FirstName: | PATRICK | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7590 AUBURN ROAD, SUITE 014 | ||||||||
Address2: | ATTN: MED STAFF | ||||||||
City: | CONCORD TWP | ||||||||
State: | OH | ||||||||
PostalCode: | 440779176 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4403541899 | ||||||||
FaxNumber: | 4403541845 | ||||||||
Practice Location | |||||||||
Address1: | 5105 SOM CENTER ROAD | ||||||||
Address2: | SUITE 202 | ||||||||
City: | WILLOUGHBY | ||||||||
State: | OH | ||||||||
PostalCode: | 44094 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4409535760 | ||||||||
FaxNumber: | 4409535761 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/18/2006 | ||||||||
LastUpdateDate: | 04/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35-083891 | OH | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP2900X | 35-083891 | OH | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 2703604 | 05 | OH |   | MEDICAID | P00364268 | 01 | OH | RAILROAD MEDICARE | OTHER | 1841239274 | 01 | OH | PARTNERS PHYSICIAN GROUP TYPE 2 NPI # | OTHER | 2551671 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICAID GROUP # | OTHER | 000000503650 | 01 | OH | ANTHEM | OTHER | 7987839 | 01 | OH | AETNA | OTHER | 9338635 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICARE GROUP # | OTHER |