Provider Demographics
NPI:1134393523
Name:NORTHERN OHIO MEDICAL SPECIALISTS
Entity type:Organization
Organization Name:NORTHERN OHIO MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-6161
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0358
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:2020 HAYES AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4793
Practice Address - Country:US
Practice Address - Phone:419-625-1236
Practice Address - Fax:419-625-1238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN OHIO MEDICAL SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-16
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4258080004Medicare NSC