Provider Demographics
NPI:1760654123
Name:PAX MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:PAX MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIMIZIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMANAMBU
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:330-375-0000
Mailing Address - Street 1:1655 W MARKET ST STE L
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7021
Mailing Address - Country:US
Mailing Address - Phone:330-375-0000
Mailing Address - Fax:330-375-0002
Practice Address - Street 1:1655 W MARKET ST STE L
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7021
Practice Address - Country:US
Practice Address - Phone:330-375-0000
Practice Address - Fax:330-375-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074641Medicaid
OHG73220Medicare UPIN
OH0074641Medicaid