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	:	1740410521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN OHIO MEDICAL SPECIALISTS,LLC

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-609-1112
Fax Number	:	419-502-3537

Provider Business Practice Location Address
First Line	:	15299 BAGLEY RD
Second Line	:	SUITE 100
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4823
Country	:	US
Telephone Number	:	440-885-2100
Fax Number	:	440-885-2106

Authorized Official
Title or Position	:	CEO
Name	:	JOSHUA FREDERICK
Credential	:
Telephone Number	:	419-626-6161

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	11/29/2016

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