Healthcare Provider Details

I. General information

NPI: 1245933787
Provider Name (Legal Business Name): NORTHERN OHIO MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FULTON ST STE G
PORT CLINTON OH
43452-2008
US

IV. Provider business mailing address

PO BOX 631971
CINCINNATI OH
45263-1971
US

V. Phone/Fax

Practice location:
  • Phone: 419-660-0099
  • Fax: 419-660-0098
Mailing address:
  • Phone: 419-660-0099
  • Fax: 419-660-0098

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 FREDERICK
Title or Position: CEO
Credential:
Phone: 419-626-6161