Basic Information
Provider Information | |||||||||
NPI: | 1184077240 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTHWEST OHIO ORTHOPEDICS AND SPORTS MEDICINE INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7595 COUNTY ROAD 236 | ||||||||
Address2: |   | ||||||||
City: | FINDLAY | ||||||||
State: | OH | ||||||||
PostalCode: | 458408738 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4194271984 | ||||||||
FaxNumber: | 4194272864 | ||||||||
Practice Location | |||||||||
Address1: | 3101 W US HIGHWAY 224 | ||||||||
Address2: |   | ||||||||
City: | TIFFIN | ||||||||
State: | OH | ||||||||
PostalCode: | 448838305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4194431498 | ||||||||
FaxNumber: | 4194431691 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2016 | ||||||||
LastUpdateDate: | 11/08/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BOEHM | ||||||||
AuthorizedOfficialFirstName: | MATT | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 4194273101 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NORTHWEST OHIO ORTHOPEDICS & SPORTS MEDICINE INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 32-900011 | OH | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.