Healthcare Provider Details

I. General information

NPI: 1225318280
Provider Name (Legal Business Name): OSTEOMEDII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 ENGLE RD
MIDDLEBURG HEIGHTS OH
44130-3429
US

IV. Provider business mailing address

7380 ENGLE RD
MIDDLEBURG HEIGHTS OH
44130-3429
US

V. Phone/Fax

Practice location:
  • Phone: 440-239-3438
  • Fax: 440-239-3440
Mailing address:
  • Phone: 440-239-3438
  • Fax: 440-239-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3210
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.090624
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.003789
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number50.001229
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number06776
License Number StateOH

VIII. Authorized Official

Name: SHERRI JANE TENPENNY
Title or Position: PRESIDENT
Credential: DO
Phone: 440-239-3438