Provider Demographics
NPI:1932535820
Name:NORTHWEST OHIO RHEUMATOLOGY INC
Entity Type:Organization
Organization Name:NORTHWEST OHIO RHEUMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIDEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-369-2190
Mailing Address - Street 1:PO BOX 78000
Mailing Address - Street 2:DEPT 78190
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1907
Mailing Address - Country:US
Mailing Address - Phone:800-514-4390
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:132 GARAU ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1086
Practice Address - Country:US
Practice Address - Phone:419-358-0132
Practice Address - Fax:419-358-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDU2173OtherRAILROAD MEDICARE
OH0091899Medicaid
OH0091899Medicaid