Healthcare Provider Details

I. General information

NPI: 1003156951
Provider Name (Legal Business Name): OHIO SPINE AND BODY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 W RIVER RD N
ELYRIA OH
44035-2779
US

IV. Provider business mailing address

69 LINCOLN BLVD SUITE A #262
LINCOLN CA
95648-6303
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-9000
  • Fax: 440-324-2849
Mailing address:
  • Phone: 916-276-6471
  • Fax: 916-409-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6850710001
License Number StateOH

VIII. Authorized Official

Name: MRS. AMY R SHERROD
Title or Position: CFO
Credential:
Phone: 916-276-6471