NPIMap

Organization Active NPI

Lorain County Health & Dentistry

  • Pediatrics Physician
  • Lorain, OH
National Provider Identifier
1407024870
Registry record updated Jun 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LORAIN COUNTY HEALTH & DENTISTRY
Practice address
1205 Broadway
Lorain, OH 44052-3409
Phone
(440) 240-1655
Fax
(440) 245-1218
NPI assigned
Feb 19, 2008
Last updated
Jun 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Wiersma
Title
Ceo
Phone
(440) 233-1059

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

1205 Broadway
Lorain, OH 44052-3409

Mailing address

1205 Broadway
Lorain, OH 44052-3409
Phone (440) 240-1655

Other identifiers 1

IdentifierTypeStateIssuer
2295118MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Lorain County Health Denti26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1407024870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 BROADWAY",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440523409",
            "telephone_number": "440-240-1655",
            "fax_number": "440-245-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 BROADWAY",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440523409",
            "telephone_number": "440-240-1655",
            "fax_number": "440-245-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORAIN COUNTY HEALTH & DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "WIERSMA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "440-233-1059"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2295118",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.