| Stark Primary Care, Llc | |
|
1455 Harrison Ave Nw Suite 108 Canton OH 44708-2621 | |
| (330) 455-4999 | |
| Not Available |
| Full Name | Stark Primary Care, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1455 Harrison Ave Nw, Canton, Ohio |
| Authorized Official Name and Position | Venkatesan Ravishankar (PRESIDENT) |
| Authorized Official Contact | 3304554999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stark Primary Care, Llc 1455 Harrison Ave Nw Suite 108 Canton OH 44708-2621 Ph: (330) 455-4999 | Stark Primary Care, Llc 1455 Harrison Ave Nw Suite 108 Canton OH 44708-2621 Ph: (330) 455-4999 |
| NPI Number | 1851578249 |
|---|---|
| Provider Enumeration Date | 01/28/2008 |
| Last Update Date | 09/05/2013 |
| Medicare PECOS PAC ID | 7214010347 |
|---|---|
| Medicare Enrollment ID | O20080213000430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851578249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 35072622 (Ohio) | Primary |
| Provider Name | Venkatesan Ravishankar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942310263 PECOS PAC ID: 5597848622 Enrollment ID: I20080213000423 |
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