Provider Demographics
NPI:1538247531
Name:NORTHERN OHIO MEDICAL SPECIALISTS IMAGING CENTER
Entity type:Organization
Organization Name:NORTHERN OHIO MEDICAL SPECIALISTS IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-6161
Mailing Address - Street 1:2800 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7248
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-626-7030
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BLDG C
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-621-0858
Practice Address - Fax:419-621-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9316271Medicare ID - Type UnspecifiedGROUP ID NUMBER