Basic Information
| Provider Information | |||||||||
| NPI: | 1952383135 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NES OHIO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 65274 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282650274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003778721 | ||||||||
| FaxNumber: | 3045232241 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 MOUNT SAINT MARYS DR | ||||||||
| Address2: | |||||||||
| City: | NELSONVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457641280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407531931 | ||||||||
| FaxNumber: | 7407533177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORRA | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8003778721 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000032226 | 01 | OH | GROUP BCBS # | OTHER | 0308796 | 05 | OH | MEDICAID |