Premier Gynecology, Inc.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

35072306K Issued in OH

Legal business name

PREMIER GYNECOLOGY, INC.

Practice address

4256 Fulton Dr NW
Ste B
Canton, OH 44718-2879

Phone

(330) 546-0751

Fax

(330) 956-5237

NPI assigned

Jun 14, 2011

Organization subpart

No

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

Authorized official

Name

Joann Krivetzky, MD

Title

President

Phone

(330) 546-0751

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308009600000",
    "number": "1790070191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4256 FULTON DR NW",
            "address_2": "STE B",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182879",
            "telephone_number": "330-546-0751",
            "fax_number": "330-956-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4256 FULTON DR NW",
            "address_2": "STE B",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182879",
            "telephone_number": "330-546-0751",
            "fax_number": "330-956-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER GYNECOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-14",
        "status": "A",
        "authorized_official_last_name": "KRIVETZKY",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-546-0751",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OH",
            "license": "35072306K",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russelle Lameese Pratt
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• Preflogroup
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• Premier Specialists in Infectious Disease, LLC
• Andrew Grant Prendergast
• Melissa Pressdee
• Prestige Care Services LLC

• Gynecology Physician in Canton, OH
• Providers in Canton, OH by specialty
• Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.