Josephine F Collaco MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35038665 Issued in OH

Legal business name

JOSEPHINE F COLLACO MD LLC

Practice address

1050 Isaac Streets Dr
Suite 104
Oregon, OH 43616-3291

Phone

(419) 698-4642

Fax

(419) 698-8597

NPI assigned

Apr 25, 2012

Organization subpart

No

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

Authorized official

Name

Mike Polo

Title

Operations Manager

Phone

(440) 234-8833

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1427316637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 LUCERNE DR",
            "address_2": "SUITE 405",
            "city": "MIDDLEBURG HTS",
            "state": "OH",
            "postal_code": "441306503",
            "telephone_number": "800-556-6236",
            "fax_number": "440-234-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 ISAAC STREETS DR",
            "address_2": "SUITE 104",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163291",
            "telephone_number": "419-698-4642",
            "fax_number": "419-698-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPHINE F COLLACO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "POLO",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "440-234-8833"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35038665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "000000162663",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Oregon, OH
• Providers in Oregon, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.