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General NPI Number Information
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NPI Number | 1477547925
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL INTERNAL MEDICINE INC
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 32 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-2480
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Country | US
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Telephone | 419-663-8808
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Fax | 419-668-5334
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Provider Business Mailing Address
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Address Line | 32 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-2480
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Country | US
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Telephone | 419-663-8808
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Fax | 419-668-5334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY WAYNE MUMMERT
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Credential | D.O.
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Telephone | 419-663-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | OH
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