Great Lakes Rehab, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

35 071295 Issued in OH

Legal business name

GREAT LAKES REHAB, LLC

Practice address

6674 Tippecanoe Rd
Suite # 1
Canfield, OH 44406-9149

Phone

(330) 533-0919

Fax

(330) 533-1732

NPI assigned

Mar 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Eric T Gross, M.D.

Title

President

Phone

(330) 533-0919

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eric T. Gross, M.D. Doing business as

Locations

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1154380822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6674 TIPPECANOE RD",
            "address_2": "SUITE # 1",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069149",
            "telephone_number": "330-533-0919",
            "fax_number": "330-533-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6674 TIPPECANOE RD",
            "address_2": "SUITE # 1",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069149",
            "telephone_number": "330-533-0919",
            "fax_number": "330-533-1732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-533-0919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "35 071295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2118578",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eric T. Gross, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annmarie Kathleen Ginnis
• Alexis Marie Girgus, BSW LSW
• Mary Gomez, PHARMD
• Cynthia M Goodall, LPN
• John James Graham, M.D.
• Gregory S. Zinni MD LLC
• Gregory S. Zinni, M.D., Inc.
• Eric T Gross, M.D.
• Cynthia Habuda
• Patrick Hagy, PA-C

• Physical Medicine & Rehabilitation Physician in Canfield, OH
• Providers in Canfield, OH by specialty
• Physical Medicine & Rehabilitation Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.