Provider Demographics
NPI:1730381369
Name:NORTH CENTRAL OHIO EAR NOSE & THROAT SURGEONS INC
Entity type:Organization
Organization Name:NORTH CENTRAL OHIO EAR NOSE & THROAT SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-566-7198
Mailing Address - Street 1:3540 BURBANK RD # 108
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8539
Mailing Address - Country:US
Mailing Address - Phone:330-621-8013
Mailing Address - Fax:330-682-2115
Practice Address - Street 1:3540 BURBANK RD # 108
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8539
Practice Address - Country:US
Practice Address - Phone:330-621-8013
Practice Address - Fax:330-682-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086045207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH130939Medicare UPIN