Provider Demographics
NPI:1295915569
Name:NORTHERN OHIO ARTHRITIS CENTER, INC
Entity type:Organization
Organization Name:NORTHERN OHIO ARTHRITIS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PERHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-934-2200
Mailing Address - Street 1:36855 AMERICAN WAY
Mailing Address - Street 2:STE A
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4054
Mailing Address - Country:US
Mailing Address - Phone:440-934-2200
Mailing Address - Fax:440-934-2213
Practice Address - Street 1:36855 AMERICAN WAY
Practice Address - Street 2:STE A
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4054
Practice Address - Country:US
Practice Address - Phone:440-934-2200
Practice Address - Fax:440-934-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054958207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738063Medicaid
OH0738063Medicaid
OHDD0215Medicare PIN
OH4154811Medicare PIN