Healthcare Provider Details

I. General information

NPI: 1255521514
Provider Name (Legal Business Name): NORTHERN OHIO MEDICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 02/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N SANDUSKY ST SUITE B
BELLEVUE OH
44811-1180
US

IV. Provider business mailing address

521 N SANDUSKY ST SUITE B
BELLEVUE OH
44811-1180
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-6267
  • Fax: 419-483-1614
Mailing address:
  • Phone: 419-483-6267
  • Fax: 419-483-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35059687
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35059687
License Number StateOH

VIII. Authorized Official

Name: BRADLEY P SMITH
Title or Position: CEO
Credential:
Phone: 419-626-6161