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General NPI Number Information
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NPI Number | 1427231430
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE OF NORTHWEST OHIO, INC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 605 3RD AVE BLG B STE D
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City | FREMONT
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State | OH
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Zip | 43420-3269
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Country | US
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Telephone | 419-355-8070
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Fax | 419-355-1109
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Provider Business Mailing Address
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Address Line | 605 3RD AVE BLG B STE D
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City | FREMONT
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State | OH
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Zip | 43420-3269
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Country | US
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Telephone | 419-355-8070
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Fax | 419-355-1109
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MICHAEL MAURIC
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Credential | DO
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Telephone | 419-355-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | OH
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