Healthcare Provider Details

I. General information

NPI: 1467047167
Provider Name (Legal Business Name): OHIO NEUROLOGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 STATE ROUTE 113
BELLEVUE OH
44811-9708
US

IV. Provider business mailing address

5433 STATE ROUTE 113
BELLEVUE OH
44811-9708
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-2403
  • Fax: 419-301-0003
Mailing address:
  • Phone: 419-483-2403
  • Fax: 419-301-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN BENEDICT
Title or Position: PRESIDENT
Credential: MD
Phone: 419-366-1221