| Corporation | |
|
36465 Detroit Rd Avon OH 44011-1576 | |
| (440) 934-5236 | |
| Not Available |
| Full Name | Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 36465 Detroit Rd, Avon, Ohio |
| Authorized Official Name and Position | Edgar R M Marr (OWNER) |
| Authorized Official Contact | 4409345236 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corporation 36465 Detroit Rd Avon OH 44011-1576 Ph: (440) 934-5236 | Corporation 36465 Detroit Rd Avon OH 44011-1576 Ph: (440) 934-5236 |
| NPI Number | 1851464002 |
|---|---|
| Provider Enumeration Date | 11/16/2006 |
| Last Update Date | 02/22/2008 |
| Medicare PECOS PAC ID | 0840322640 |
|---|---|
| Medicare Enrollment ID | O20100714000507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851464002 | NPI | - | NPPES |
| 0984592 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Edgar R Marr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649375049 PECOS PAC ID: 3173655982 Enrollment ID: I20100714000583 |
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