Healthcare Provider Details

I. General information

NPI: 1609230127
Provider Name (Legal Business Name): OG MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 MARKET ST STE 6
BOARDMAN OH
44512-2915
US

IV. Provider business mailing address

5815 MARKET ST STE 6
BOARDMAN OH
44512-2915
US

V. Phone/Fax

Practice location:
  • Phone: 330-259-9575
  • Fax: 330-259-9576
Mailing address:
  • Phone: 330-259-9575
  • Fax: 330-259-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: OMAR GARCIA
Title or Position: OWNER
Credential: DC
Phone: 330-259-9575