Provider Demographics
NPI:1174610398
Name:STARK COUNTY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:STARK COUNTY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-499-3377
Mailing Address - Street 1:4810 MUNSON ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3613
Mailing Address - Country:US
Mailing Address - Phone:330-499-3377
Mailing Address - Fax:330-499-3999
Practice Address - Street 1:4810 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3613
Practice Address - Country:US
Practice Address - Phone:330-499-3377
Practice Address - Fax:330-499-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076280B173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2528063Medicaid
OHG99582Medicare UPIN