Provider Demographics
NPI:1710176334
Name:OCCUPATIONAL MEDICINE OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAADEP,FACOEM
Authorized Official - Phone:419-448-3820
Mailing Address - Street 1:3101 W US HIGHWAY 224
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8305
Mailing Address - Country:US
Mailing Address - Phone:419-448-3820
Mailing Address - Fax:419-448-3822
Practice Address - Street 1:3101 W US HIGHWAY 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8305
Practice Address - Country:US
Practice Address - Phone:419-448-3820
Practice Address - Fax:419-448-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056832261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1629015482OtherINDIVIDUAL NPI