1841465309 NPI number — NORTHERN OHIO MEDICAL SPECIALISTS,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841465309 NPI number — NORTHERN OHIO MEDICAL SPECIALISTS,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN OHIO MEDICAL SPECIALISTS,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841465309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44871-0378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-609-1112
Provider Business Mailing Address Fax Number:
419-609-1123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 INDEPENDENCE WAY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
CLYDE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43410-9811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-547-2810
Provider Business Practice Location Address Fax Number:
419-549-3196
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FREDERICK
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
419-609-1112

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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