MEDICARE: NORTHWEST OHIO URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35067481	OH
2	207Q00000X	Family Medicine Physician	35081708	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508277237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST OHIO URGENT CARE LLC

Provider Business Mailing Address
First Line	:	1421 S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7413
Country	:	US
Telephone Number	:	419-725-6290
Fax Number	:	419-725-6287

Provider Business Practice Location Address
First Line	:	1421 S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7413
Country	:	US
Telephone Number	:	419-725-6290
Fax Number	:	419-725-6287

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ARSHAD HUSAIN
Credential	:	MD
Telephone Number	:	419-725-6290

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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