MEDICARE: NORTHERN OHIO MEDICAL SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508418955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN OHIO MEDICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 631971
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1971
Country	:	US
Telephone Number	:	419-626-6161
Fax Number	:	419-502-3537

Provider Business Practice Location Address
First Line	:	300 ALLEN BRADLEY DR
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6130
Country	:	US
Telephone Number	:	844-746-8537
Fax Number	:	216-450-1810

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	DAWN M WITTER
Credential	:
Telephone Number	:	419-626-6161

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	08/30/2023

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