Provider Demographics
NPI:1730226069
Name:NORWALK EMERGENCY SERVICES, INC.
Entity type:Organization
Organization Name:NORWALK EMERGENCY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-3433
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:BLDG. E #4
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-824-3433
Mailing Address - Fax:419-824-0216
Practice Address - Street 1:272 BENEDICT AVE
Practice Address - Street 2:FISHER-TITUS MEDCIAL CENTER
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:800-589-3862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCN0371OtherMEDICARE RAILROAD
OH9248411Medicare PIN