Healthcare Provider Details

I. General information

NPI: 1205139623
Provider Name (Legal Business Name): MEMORIAL PROFESSIONAL SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3200
US

IV. Provider business mailing address

715 S TAFT AVE
FREMONT OH
43420-3200
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-7321
  • Fax:
Mailing address:
  • Phone: 419-332-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT W LITTELMANN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-334-6661