Basic Information
| Provider Information | |||||||||
| NPI: | 1023037140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST OHIO ORTHOPEDICS AND SPORTS MEDICINE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7595 COUNTY ROAD 236 | ||||||||
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| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458408738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194271984 | ||||||||
| FaxNumber: | 4194272524 | ||||||||
| Practice Location | |||||||||
| Address1: | 7595 COUNTY ROAD 236 | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458408738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194271984 | ||||||||
| FaxNumber: | 4194272864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | DAMON | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4194273104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2287109 | 05 | OH | MEDICAID |