Provider Demographics
NPI:1538353750
Name:NORTHWEST OHIO MEDICINE, INC
Entity type:Organization
Organization Name:NORTHWEST OHIO MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-486-8885
Mailing Address - Street 1:4129 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4809
Mailing Address - Country:US
Mailing Address - Phone:419-479-2665
Mailing Address - Fax:419-479-2639
Practice Address - Street 1:4129 N HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4809
Practice Address - Country:US
Practice Address - Phone:419-479-2665
Practice Address - Fax:419-479-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3369101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMA0424711Medicare PIN
OHCK4338Medicare PIN