Healthcare Provider Details

I. General information

NPI: 1366478497
Provider Name (Legal Business Name): NORTH CENTRAL OHIO PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST SUITE 220
LIMA OH
45801-5910
US

IV. Provider business mailing address

770 W HIGH ST SUITE 220
LIMA OH
45801-5910
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-3385
  • Fax: 419-221-3585
Mailing address:
  • Phone: 419-221-3385
  • Fax: 419-221-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARLENE M HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 419-221-3385