Provider Demographics
NPI:1538307350
Name:PHYSICIAN'S CHOICE HOSPITAL - FREMONT PHYSICIANS
Entity Type:Organization
Organization Name:PHYSICIAN'S CHOICE HOSPITAL - FREMONT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MCTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:419-461-1057
Mailing Address - Street 1:11537 W BLOOM RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9671
Mailing Address - Country:US
Mailing Address - Phone:419-461-1057
Mailing Address - Fax:
Practice Address - Street 1:2390 ENTERPRISE DR.
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:419-461-1057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063632207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty