Organization
MARYMOUNT PRIMARY CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER P WALCHANOWICZ (PRACTICE MANAGER)
(440) 543-8855
Entity
Organization
Contact information
Practice address
17747 CHILLICOTHE RD, SUITE 100, CHAGRIN FALLS, OH 44023-4739
(440) 543-8855
(440) 543-2470
Mailing address
17747 CHILLICOTHE RD, SUITE 100, CHAGRIN FALLS, OH 44023-4739
(440) 543-8855
(440) 543-2470
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2083X0100X
Occupational Medicine Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028432
ANTHEM
OH
05
—
0139719
—
OH
Enumeration date
01/31/2006
Last updated
07/28/2008
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