Provider Demographics
NPI:1366522583
Name:ST. GEORGE MEDICAL PRACTICE, INC.
Entity type:Organization
Organization Name:ST. GEORGE MEDICAL PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-652-3000
Mailing Address - Street 1:1254 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:SUITE 3 A
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4651
Mailing Address - Country:US
Mailing Address - Phone:330-652-3000
Mailing Address - Fax:
Practice Address - Street 1:1254 YOUNGSTOWN WARREN RD
Practice Address - Street 2:SUITE 3 A
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4651
Practice Address - Country:US
Practice Address - Phone:330-652-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty