Healthcare Provider Details

I. General information

NPI: 1740418011
Provider Name (Legal Business Name): NORTHERN OHIO MEDICAL SPECIALISTS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 N RIVER RD
FREMONT OH
43420-9760
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-355-9440
  • Fax: 419-355-9443
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: JOSHUA G FREDERICK
Title or Position: CEO
Credential:
Phone: 419-626-6161