Provider Demographics
NPI:1225085855
Name:NORTHERN OHIO MEDICAL SPECIALISTS LLC
Entity type:Organization
Organization Name:NORTHERN OHIO MEDICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-6161
Mailing Address - Street 1:PO BOX 631971
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1971
Mailing Address - Country:US
Mailing Address - Phone:419-462-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:3004 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5321
Practice Address - Country:US
Practice Address - Phone:419-609-1112
Practice Address - Fax:419-609-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207RP1001X, 207RS0010X, 207V00000X, 207X00000X, 207XS0114X, 207XX0005X, 207Y00000X, 207YX0007X, 2084N0400X, 208600000X
OH207RG0100X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH8454OtherMEDICARE RAILROAD
OH2253556Medicaid
OH9313601Medicare PIN
OH4258080006Medicare NSC
OH4258080002Medicare NSC
OH4258080008Medicare NSC
OH4258080018Medicare NSC
OH2253556Medicaid
OH4258080007Medicare NSC
OH4258080002Medicare NSC
OH4258080016Medicare NSC
OH4258080004Medicare NSC
OH4258080006Medicare NSC
OH4258080008Medicare NSC
OH4258080012Medicare NSC
OH4258080013Medicare NSC
OH4258080019Medicare NSC
OH4258080010Medicare NSC
OH4258080014Medicare NSC
OH4258080011Medicare NSC