Provider Demographics
NPI:1659542322
Name:RANDALL C OREM DO INC
Entity Type:Organization
Organization Name:RANDALL C OREM DO INC
Other - Org Name:ADVANCED CARDIOVASCULAR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:OREM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-497-1200
Mailing Address - Street 1:1103 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8130
Mailing Address - Country:US
Mailing Address - Phone:937-497-1200
Mailing Address - Fax:937-497-7013
Practice Address - Street 1:1103 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8130
Practice Address - Country:US
Practice Address - Phone:937-497-1200
Practice Address - Fax:937-497-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138305Medicaid
OH9271091Medicare PIN