Provider Demographics
NPI:1891734786
Name:NORTHEASTERN OHIO SURGICAL SPECILAIST
Entity Type:Organization
Organization Name:NORTHEASTERN OHIO SURGICAL SPECILAIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-945-7144
Mailing Address - Street 1:1860 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1422
Mailing Address - Country:US
Mailing Address - Phone:330-945-7144
Mailing Address - Fax:330-945-7275
Practice Address - Street 1:1860 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1422
Practice Address - Country:US
Practice Address - Phone:330-945-7144
Practice Address - Fax:330-945-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004141208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0794118Medicaid
OHNO9279191Medicare ID - Type Unspecified