Healthcare Provider Details

I. General information

NPI: 1972978583
Provider Name (Legal Business Name): NES OF SANDUSKY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 05/17/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MICHIGAN AVE
LOGANSPORT IN
46947-1528
US

IV. Provider business mailing address

PO BOX 31118
BELFAST ME
04915-0140
US

V. Phone/Fax

Practice location:
  • Phone: 574-753-7541
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-697-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MOORE
Title or Position: CFO
Credential:
Phone: 415-435-4591