Organization
MVES AUSTINTOWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA REESE (PROVIDER ENROLLMENT OFFICER)
(855) 687-0618
Entity
Organization
Contact information
Practice address
6252 MAHONING AVE, AUSTINTOWN, OH 44515-2003
(844) 474-4019
Mailing address
4535 DRESSLER RD NW, CANTON, OH 44718-2545
(330) 994-4409
(330) 492-8489
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000349348
ANTHEM
OH
Enumeration date
05/17/2006
Last updated
02/24/2023
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