Basic Information
| Provider Information | |||||||||
| NPI: | 1073783791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NWO HEALTH PARTNERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7595 COUNTY ROAD 236 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458408738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194273030 | ||||||||
| FaxNumber: | 4194273034 | ||||||||
| Practice Location | |||||||||
| Address1: | 7595 COUNTY ROAD 236 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458408738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194273030 | ||||||||
| FaxNumber: | 4194273034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 06/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOEHM | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4194271984 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 2867849 | 05 | OH | MEDICAID |