Provider Demographics
NPI:1437284015
Name:NORTH COAST ORTHOPEDIC SURGERY INC.
Entity Type:Organization
Organization Name:NORTH COAST ORTHOPEDIC SURGERY 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:M
Authorized Official - Last Name:BONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-355-9800
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-0546
Mailing Address - Country:US
Mailing Address - Phone:419-355-9800
Mailing Address - Fax:
Practice Address - Street 1:629 BARTSON RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9672
Practice Address - Country:US
Practice Address - Phone:419-355-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2203083Medicaid
OH1187880001OtherMEDICARE DME MAC B