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Organization

NES OF SHELBY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER MOORE (CFO)
(415) 435-4591
Entity
Organization

Contact information

Practice address
20 MORRIS RD, SHELBY, OH 44875-1152
(419) 342-5015
Mailing address
PO BOX 636482, CINCINNATI, OH 45263-0001
(800) 377-8721
(304) 697-1155

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000640740
ANTHEM BCBS
OH
05
2983615
OH
01
DP5709
RR MEDICARE
Enumeration date
08/26/2009
Last updated
04/30/2013
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