Provider Demographics
NPI:1538486055
Name:PHYSICIANS CHOICE HOSPITAL - FREMONT PHYSICIANS
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE HOSPITAL - FREMONT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
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:567-201-2911
Mailing Address - Street 1:2390 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-8507
Mailing Address - Country:US
Mailing Address - Phone:567-201-2911
Mailing Address - Fax:567-201-2914
Practice Address - Street 1:2390 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-8507
Practice Address - Country:US
Practice Address - Phone:567-201-2911
Practice Address - Fax:567-201-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty