Shelley J Fogt (NPI# 1861856015, PAC ID# 5092090795) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1861856015 |
| PAC ID by PECOS | 5092090795 |
| Professional Enrollment ID | I20170320002639 |
| Full Name | Shelley J Fogt |
| Organization Legal Name | LIMA MEMORIAL PROFESSIONAL CORPORATION |
| Address |
322 E Main St Russells Point OH 43348-9601 |
| Phone Number | 9378422318 |
| Gender | F |
| Graduation Year | 2015 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 1254232184 |
| Number of Group Practice Members | 107 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 360009 | LIMA MEMORIAL HEALTH SYSTEM |
| 360066 | ST RITA'S MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1001 Bellefontaine Ave, Lima, OH 45804-2800 | LIMA MEMORIAL PROFESSIONAL CORPORATION | |
| 240 W Northern Ave, Suite 3, Lima, OH 45801-2839 | 4199988265 | LIMA MEMORIAL PROFESSIONAL CORPORATION |
| 322 E Main St, Russells Point, OH 43348-9601 | 9378422318 | LIMA MEMORIAL PROFESSIONAL CORPORATION |
| Organization Legal Name | LIMA MEMORIAL PROFESSIONAL CORPORATION |
| Physicians | 107 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Zachary Charles Niese | Nurse Practitioner | Lima Memorial Professional Corporation | 322 E Main St, Russells Point, OH 43348-9601 |
| Trisha M Kleman | Nurse Practitioner | Lima Memorial Professional Corporation | 240 W Northern Ave, Suite 3, Lima, OH 45801-2839 |
| Alicia Thornton | Physician Assistant | Lima Memorial Professional Corporation | 1001 Bellefontaine Ave, Lima, OH 45804-2800 |
| Marilyn E Roberts | Nurse Practitioner | Lima Memorial Professional Corporation | 525 N Eastown Rd, Suite A, Lima, OH 45807-2268 |
| Shannon R Wesley | Colorectal Surgery (proctology) | Lima Memorial Professional Corporation | 1003 Bellefontaine Ave, Suite 125, Lima, OH 45804-1867 |
| Monica W Loke | Neurosurgery | Lima Memorial Professional Corporation | 1005 Bellefontaine Ave, Suite 350, Lima, OH 45804-2885 |
| Jennifer Maag | Family Medicine | Lima Memorial Professional Corporation | 102 Putnam Pkwy, Ottawa, OH 45875-8657 |
| Susan M Kaufman | Family Medicine | Lima Memorial Professional Corporation | 1211 E Columbus St, Kenton, OH 43326-1760 |
| Sarat B Kuchipudi | Pulmonary Disease | Lima Memorial Professional Corporation | 528 W Market St, Suite 200a, Lima, OH 45801-4762 |
| Marjorie A Demund | Obstetrics/gynecology | Lima Memorial Professional Corporation | 1220 E Elm St, Suite 101, Lima, OH 45804-2803 |
| Street Address |
322 E MAIN ST |
| City | RUSSELLS POINT |
| State | OH |
| Zip | 43348-9601 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Zachary Charles Niese | Nurse Practitioner | Lima Memorial Professional Corporation | 322 E Main St, Russells Point, OH 43348-9601 |
| Randall M Johnson | Physician Assistant | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| David James Griffin | Physician Assistant | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| Douglas Jordan Grunwald | Gastroenterology | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| William M Dickerson Jr. | Optometry | 322 E Main St, Tupelo, MS 38804-4026 | |
| Sara C Petee | Nurse Practitioner | Lima Memorial Professional Corporation | 322 E Main St, Russells Point, OH 43348-9601 |
| Anthony I Capobianco | Physician Assistant | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| Elizabeth A Bull | Nurse Practitioner | Lima Memorial Professional Corporation | 322 E Main St, Russells Point, OH 43348-9601 |
| Courtney E Calandro | Physician Assistant | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| Kate L Charron | Physician Assistant | Physicians Alliance of Connecticut LLC | 322 E Main St, Branford, CT 06405-3136 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Thomas Darrah | Family Practice | Costin Family Practice, Inc. | 303 E Main St, Russells Point, OH 43348-9626 |
| City | RUSSELLS POINT |
| Zip Code | 43348 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | RUSSELLS POINT + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Shelley J Fogt.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.