Provider Demographics
NPI:1033206610
Name:HEALTHCARE SPECIALISTS OF SOUTHEASTERN OHIO, INC
Entity Type:Organization
Organization Name:HEALTHCARE SPECIALISTS OF SOUTHEASTERN OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-4530
Mailing Address - Street 1:945 BETHESDA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0801
Mailing Address - Country:US
Mailing Address - Phone:740-454-4530
Mailing Address - Fax:740-454-4648
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-454-4530
Practice Address - Fax:740-454-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPR14115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9296901Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER