Healthcare Provider Details

I. General information

NPI: 1467628966
Provider Name (Legal Business Name): NES NORTHEAST OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

PO BOX 632315
BALTIMORE MD
21263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9771
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT MORRA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 631-265-7450