Organization
MARYMOUNT PRIMARY CARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER P WALCHANOWICZ (PRACTICE MANAGER)
(440) 543-8855
Entity
Organization
Contact information
Practice address
2001 E ROYALTON RD, BROADVIEW HEIGHTS, OH 44147-2811
(440) 717-6100
(440) 546-1382
Mailing address
2001 E ROYALTON RD, BROADVIEW HEIGHTS, OH 44147-2811
(440) 717-6100
(440) 546-1382
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000564045
ANTHEM
OH
05
—
2082160
—
OH
Enumeration date
08/29/2007
Last updated
05/27/2008
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