=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982619755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST OHIO PRIMARY CARE PHYSICIANS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 DIXIE HWY
-----------------------------------------------------
City | ROSSFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43460-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-666-6682
-----------------------------------------------------
Fax | 419-666-4340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 DIXIE HWY
-----------------------------------------------------
City | ROSSFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43460-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-666-6682
-----------------------------------------------------
Fax | 419-666-4340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. IRSHAD HASAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 419-666-6682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------