Provider Demographics
NPI:1174703169
Name:NICHOLAS V RIMEDIO
Entity type:Organization
Organization Name:NICHOLAS V RIMEDIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:RIMEDIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-686-6609
Mailing Address - Street 1:38 MUNROE FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1538
Mailing Address - Country:US
Mailing Address - Phone:330-686-6609
Mailing Address - Fax:330-686-6634
Practice Address - Street 1:38 MUNROE FALLS AVE
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1538
Practice Address - Country:US
Practice Address - Phone:330-686-6609
Practice Address - Fax:330-686-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001482261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2158392Medicaid
OHD89875Medicare UPIN
OH2158392Medicaid