Healthcare Provider Details

I. General information

NPI: 1861863490
Provider Name (Legal Business Name): NORTHEASTERN OHIO INFECTIOUS DISEASE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PARMALEE AVE SUITE # 610
YOUNGSTOWN OH
44510-1716
US

IV. Provider business mailing address

540 PARMALEE AVE SUITE # 610
YOUNGSTOWN OH
44510-1716
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-4369
  • Fax: 330-744-1728
Mailing address:
  • Phone: 330-744-4369
  • Fax: 330-744-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberCOA17837NP
License Number StateOH

VIII. Authorized Official

Name: MRS. KATHY A. HURDLEY
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 330-270-2350