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General NPI Number Information
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NPI Number | 1609959931
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN OHIO MEDICAL SPECIALISTS INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 470 WHITE POND DR STE 100
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City | AKRON
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State | OH
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Zip | 44320-1185
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Country | US
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Telephone | 330-869-8530
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Fax | 330-869-8539
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Provider Business Mailing Address
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Address Line | 470 WHITE POND DR SUITE 100
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City | AKRON
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State | OH
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Zip | 44320-1185
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Country | US
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Telephone | 330-869-8530
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Fax | 330-869-8539
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. SHANNON RAE SCOTT
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Credential | CMC
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Telephone | 330-869-8530
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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 | 35-07-3269-W
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-07-3029M
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP67943
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-07-7486M
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License Number State | OH
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