Provider Demographics
NPI:1174948418
Name:LOUIS DEMICCO DO INC.
Entity type:Organization
Organization Name:LOUIS DEMICCO DO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS PROCESSER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRUZINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-354-5643
Mailing Address - Street 1:263 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3105
Mailing Address - Country:US
Mailing Address - Phone:440-354-5643
Mailing Address - Fax:440-354-5645
Practice Address - Street 1:263 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3105
Practice Address - Country:US
Practice Address - Phone:440-354-5643
Practice Address - Fax:440-354-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH233111N00000X
OH012350225100000X
OH340067482081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty