Healthcare Provider Details

I. General information

NPI: 1972837284
Provider Name (Legal Business Name): NW OHIO SPINE AND SPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WESTFIELD DR SUITE 2
ARCHBOLD OH
43502-1056
US

IV. Provider business mailing address

7071 W CENTRAL AVE SUITE C
TOLEDO OH
43617-2700
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-1369
  • Fax: 419-843-8402
Mailing address:
  • Phone: 419-843-1369
  • Fax: 419-843-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM G JAMES JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-843-1369