Healthcare Provider Details

I. General information

NPI: 1538486055
Provider Name (Legal Business Name): PHYSICIANS CHOICE HOSPITAL - FREMONT PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 ENTERPRISE ST
FREMONT OH
43420-8507
US

IV. Provider business mailing address

2390 ENTERPRISE ST
FREMONT OH
43420-8507
US

V. Phone/Fax

Practice location:
  • Phone: 567-201-2911
  • Fax: 567-201-2914
Mailing address:
  • Phone: 567-201-2911
  • Fax: 567-201-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROME ANTHONY MCTAGUE
Title or Position: MANAGER
Credential: MD, JD
Phone: 567-201-2911