| Western Lake Erie Oms Ltd. | |
|
5690 Monroe St Sylvania OH 43560-2736 | |
| (419) 479-3939 | |
| (419) 479-3933 |
| Full Name | Western Lake Erie Oms Ltd. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5690 Monroe St, Sylvania, Ohio |
| Authorized Official Name and Position | Stephen Mark Shall (PRESIDENT) |
| Authorized Official Contact | 4194793939 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Lake Erie Oms Ltd. 5690 Monroe St Sylvania OH 43560-2736 Ph: (419) 479-3939 | Western Lake Erie Oms Ltd. 5690 Monroe St Sylvania OH 43560-2736 Ph: (419) 479-3939 |
| NPI Number | 1538380662 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 07/31/2019 |
| Medicare PECOS PAC ID | 8022908136 |
|---|---|
| Medicare Enrollment ID | O20040319000945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538380662 | NPI | - | NPPES |
| 1215932504 | Other | OH | NPI NUMBER |
| 1578568861 | Other | OH | NPI NUMBER |
| 1891795233 | Other | OH | NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Stephen M Shall |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1215932504 PECOS PAC ID: 9436040458 Enrollment ID: I20040323000425 |
| Provider Name | James E Mayer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891795233 PECOS PAC ID: 7315123239 Enrollment ID: I20130619000643 |
| Provider Name | Lauren Bourell |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295908028 PECOS PAC ID: 7012205065 Enrollment ID: I20161007000554 |
| Provider Name | David A Shall |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1194968347 PECOS PAC ID: 9234439472 Enrollment ID: I20161013001042 |
| Provider Name | Aaron M Brinster |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1629393707 PECOS PAC ID: 9335417369 Enrollment ID: I20190107003209 |
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