Provider Demographics
NPI:1033569728
Name:NORTHWEST OHIO ORTHOPEDICS AND SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:NORTHWEST OHIO ORTHOPEDICS AND SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-427-3101
Mailing Address - Street 1:7595 COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8738
Mailing Address - Country:US
Mailing Address - Phone:419-427-1984
Mailing Address - Fax:419-427-2864
Practice Address - Street 1:1069 KLOTZ RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4828
Practice Address - Country:US
Practice Address - Phone:419-728-0110
Practice Address - Fax:419-728-0113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST OHIO ORTHOPEDICS & SPORTS MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-14
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32-900011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4413510004Medicare PIN