Portage Family Practice Clinic, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

34003002 Issued in OH

Legal business name

PORTAGE FAMILY PRACTICE CLINIC, INC.

Practice address

1413 Portage St NW
North Canton, OH 44720-2288

Phone

(330) 499-7591

Fax

(330) 499-0308

NPI assigned

Jan 19, 2007

Last updated

Oct 25, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Leonard D Tamburro, D.O.NPI 1790774842

Title

President

Phone

(330) 499-7591

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leonard D Tamburro, D.O.

  • Family Medicine Physician
  • North Canton, OH
  • NPI 1790774842
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319500800000",
    "number": "1083767677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 PORTAGE ST NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447202288",
            "telephone_number": "330-499-7591",
            "fax_number": "330-499-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 PORTAGE ST NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447202288",
            "telephone_number": "330-499-7591",
            "fax_number": "330-499-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE FAMILY PRACTICE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2011-10-25",
        "status": "A",
        "authorized_official_last_name": "TAMBURRO",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-499-7591",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": "34003002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0507268",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashli Pollock
• Jacqueline E Pompignano, L/PTA
• Michael D Poorman, COTA/L
• Robert Popernack Jr., LPTA
• Portable Radiology Services LLC
• Nicholas Potenzini
• Christopher John Potter, ATC
• Katelyn E Potter
• Brooke Potts, COTA
• Maria L Potts, COTA/L

• Clinic/Center in North Canton, OH
• Providers in North Canton, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.