Provider Demographics
NPI:1952724940
Name:NORTHWEST OHIO SURGICAL CENTERS, INC
Entity Type:Organization
Organization Name:NORTHWEST OHIO SURGICAL CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-517-4404
Mailing Address - Street 1:5688 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2736
Mailing Address - Country:US
Mailing Address - Phone:419-517-4404
Mailing Address - Fax:
Practice Address - Street 1:5688 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2736
Practice Address - Country:US
Practice Address - Phone:419-517-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16634261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH200060Medicare UPIN