Healthcare Provider Details

I. General information

NPI: 1841465309
Provider Name (Legal Business Name): NORTHERN OHIO MEDICAL SPECIALISTS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 INDEPENDENCE WAY SUITE 150
CLYDE OH
43410-9811
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-547-2810
  • Fax: 419-549-3196
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

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: MR. JOSHUA G FREDERICK
Title or Position: CEO
Credential:
Phone: 419-609-1112