Healthcare Provider Details

I. General information

NPI: 1427231430
Provider Name (Legal Business Name): PRIMARY CARE OF NORTHWEST OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 3RD AVE BLG B STE D
FREMONT OH
43420-3269
US

IV. Provider business mailing address

605 3RD AVE BLG B STE D
FREMONT OH
43420-3269
US

V. Phone/Fax

Practice location:
  • Phone: 419-355-8070
  • Fax: 419-355-1109
Mailing address:
  • Phone: 419-355-8070
  • Fax: 419-355-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN MICHAEL MAURIC
Title or Position: PRESIDENT
Credential: DO
Phone: 419-355-8070