Provider Demographics
NPI:1952354482
Name:NORTHERN OHIO MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHERN OHIO MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-442-7300
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 412
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-442-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2144718Medicaid
OH0977877Medicaid
OH9268513Medicare PIN
OHF93766Medicare UPIN
OHE98893Medicare UPIN
OH9268518Medicare PIN
OH9292802Medicare PIN
OHA74746Medicare UPIN
OH9292803Medicare PIN
OH9298512Medicare PIN
OHCA6832Medicare PIN
OHA17406Medicare UPIN
OH0977877Medicaid
OH9292804Medicare PIN