Provider Demographics
NPI:1508277237
Name:NORTHWEST OHIO URGENT CARE LLC
Entity Type:Organization
Organization Name:NORTHWEST OHIO URGENT CARE LLC
Other - Org Name:THE PRIMARY CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-725-6290
Mailing Address - Street 1:1421 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7413
Mailing Address - Country:US
Mailing Address - Phone:419-725-6290
Mailing Address - Fax:419-725-6287
Practice Address - Street 1:1421 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7413
Practice Address - Country:US
Practice Address - Phone:419-725-6290
Practice Address - Fax:419-725-6287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST OHIO URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081708207Q00000X
OH35067481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2375808Medicaid
OH0175859Medicaid
OH2375808Medicaid
H71995Medicare UPIN