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
4400 ROCKSIDE RD, SUITE 2100, INDEPENDENCE, OH 44131-2109
(216) 573-1300
(216) 503-5005
Mailing address
4400 ROCKSIDE RD, SUITE 2100, INDEPENDENCE, OH 44131-2109
(216) 573-1300
(216) 503-5005
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000564073
ANTHEM
OH
05
—
2698559
—
OH
Enumeration date
04/20/2007
Last updated
05/27/2008
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