Provider Demographics
NPI:1427231430
Name:PRIMARY CARE OF NORTHWEST OHIO, INC
Entity Type:Organization
Organization Name:PRIMARY CARE OF NORTHWEST OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAURIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-355-8070
Mailing Address - Street 1:605 3RD AVE
Mailing Address - Street 2:BLG B STE D
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3269
Mailing Address - Country:US
Mailing Address - Phone:419-355-8070
Mailing Address - Fax:419-355-1109
Practice Address - Street 1:605 3RD AVE
Practice Address - Street 2:BLG B STE D
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3269
Practice Address - Country:US
Practice Address - Phone:419-355-8070
Practice Address - Fax:419-355-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256473Medicaid
OH740142OtherBUCKEYE MEDICAID
OHR04778OtherSUMMACARE
OHCH7959OtherRAILROAD MEDICARE
OHCH7959OtherRAILROAD MEDICARE