Provider Demographics
NPI:1043292014
Name:ROSS PARK HOME INFUSION SERVICES
Entity Type:Organization
Organization Name:ROSS PARK HOME INFUSION SERVICES
Other - Org Name:ROSS PARK PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCKEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-283-7365
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7365
Mailing Address - Fax:740-283-7423
Practice Address - Street 1:380 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2667
Practice Address - Country:US
Practice Address - Phone:740-283-7365
Practice Address - Fax:740-283-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL.11104332BP3500X
OH3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056715Medicaid
1122040002Medicare ID - Type Unspecified