Basic Information
| Provider Information | |||||||||
| NPI: | 1972978583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NES OF SANDUSKY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31118 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049150140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003778721 | ||||||||
| FaxNumber: | 3046971155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747537541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2015 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4154354591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.