Healthcare Provider Details

I. General information

NPI: 1275005167
Provider Name (Legal Business Name): NORTHERN OHIO MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4071
US

IV. Provider business mailing address

3004 HAYES AVE
SANDUSKY OH
44870-5321
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9137
  • Fax: 330-965-9173
Mailing address:
  • Phone: 419-626-6161
  • Fax: 419-502-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HEATHER A SCHIPPEL
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 419-626-6161