Provider Demographics
NPI:1861863490
Name:NORTHEASTERN OHIO INFECTIOUS DISEASE ASSOCIATION, INC
Entity Type:Organization
Organization Name:NORTHEASTERN OHIO INFECTIOUS DISEASE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-2350
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:SUITE # 610
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-744-4369
Mailing Address - Fax:330-744-1728
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:SUITE # 610
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-744-4369
Practice Address - Fax:330-744-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA17837NP163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty