Provider Demographics
NPI:1578058434
Name:REMIS, STEPHEN RICHARD
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RICHARD
Last Name:REMIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1631
Mailing Address - Country:US
Mailing Address - Phone:330-858-5779
Mailing Address - Fax:330-319-7609
Practice Address - Street 1:89 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1631
Practice Address - Country:US
Practice Address - Phone:330-858-5779
Practice Address - Fax:330-319-7609
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH510716052302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3156285Medicaid