Provider Demographics
NPI:1003015868
Name:CHARLES SCOTT HIRTH
Entity Type:Organization
Organization Name:CHARLES SCOTT HIRTH
Other - Org Name:HOOVER ROAD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-875-3152
Mailing Address - Street 1:4151 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3617
Mailing Address - Country:US
Mailing Address - Phone:614-875-3152
Mailing Address - Fax:614-875-0090
Practice Address - Street 1:4151 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3617
Practice Address - Country:US
Practice Address - Phone:614-875-3152
Practice Address - Fax:614-875-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH46504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0537413Medicaid
OH0537413Medicaid