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General NPI Number Information
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NPI Number | 1346431269
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF NORTH OLMSTED
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 24060 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-2234
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Country | US
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Telephone | 440-779-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 24060 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-2234
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Country | US
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Telephone | 440-779-4226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICH SHEPPARD
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Credential |
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Telephone | 440-779-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 2874
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License Number State | OH
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