1487922548 NPI number — NORTHERN OHIO MEDICAL SPECIALISTS, LLC

NPI Number: 1487922548
Health Care Provider/Practitioner: NORTHERN OHIO MEDICAL SPECIALISTS, LLC

NPI Number : 1487922548 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487922548",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "NORTHERN OHIO MEDIAL SPECIALISTS,LLC",
    "ParentOrgTIN": null,
    "OrgName": "NORTHERN OHIO MEDICAL SPECIALISTS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 8372",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAROL STREAM",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60197-8372",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-609-1112",
    "MailingAddressFaxNumber": "419-609-1123",
    "FirstLinePracticeLocationAddress": "2800 HAYES AVE # BDLGC130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANDUSKY",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44870",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-502-5941",
    "PracticeLocationAddressFaxNumber": "419-502-5942",
    "EnumerationDate": "12/05/2011",
    "LastUpdateDate": "02/16/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WITTER",
    "AuthorizedOfficialFirstName": "DAWN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDNTIALING DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "216-298-1213",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0200X",
          "TaxonomyName": "Radiology Clinic/Center",
          "LicenseNumber": "10G07212003",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0200X",
          "TaxonomyName": "Radiology Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}