Provider Demographics
NPI:1679617799
Name:AUSTINTOWN INTERNAL MEDICINE, INC.
Entity type:Organization
Organization Name:AUSTINTOWN INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-799-9904
Mailing Address - Street 1:1300 S CANFIELD NILES RD
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4081
Mailing Address - Country:US
Mailing Address - Phone:330-799-9904
Mailing Address - Fax:330-799-9687
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-799-9904
Practice Address - Fax:330-799-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274420Medicaid
OH0274420Medicaid
G35892Medicare UPIN