Provider Demographics
NPI:1477547925
Name:NORTH CENTRAL INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:NORTH CENTRAL INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MUMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-663-8808
Mailing Address - Street 1:32 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2480
Mailing Address - Country:US
Mailing Address - Phone:419-663-8808
Mailing Address - Fax:419-668-5334
Practice Address - Street 1:32 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2480
Practice Address - Country:US
Practice Address - Phone:419-663-8808
Practice Address - Fax:419-668-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9285822Medicare ID - Type Unspecified