Healthcare Provider Details

I. General information

NPI: 1689719528
Provider Name (Legal Business Name): JEFFREY WADE ONGEMACH BS, CG IDHS, NREMT-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT CG-1122 U S COAST GUARD 2100 2ND ST SW, SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

COMDT CG-1122 U S COAST GUARD 2100 2ND ST SW, SUITE 5314
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-267-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberNREMT-I0682827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: