Provider Demographics
NPI:1003156951
Name:OHIO SPINE AND BODY INC
Entity type:Organization
Organization Name:OHIO SPINE AND BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-276-6471
Mailing Address - Street 1:69 LINCOLN BLVD
Mailing Address - Street 2:SUITE A #262
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-6303
Mailing Address - Country:US
Mailing Address - Phone:916-276-6471
Mailing Address - Fax:916-409-5469
Practice Address - Street 1:1599 W RIVER RD N
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2779
Practice Address - Country:US
Practice Address - Phone:440-324-9000
Practice Address - Fax:440-324-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6850710001332B00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11568OtherOHIO HME BOARD
OHCL022326150-02OtherOH PHARMACY
OH6850710001Medicare NSC
OHCL022326150-02OtherOH PHARMACY