Provider Demographics
NPI:1043926447
Name:RUGGLES, JOHNATHON
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:
Last Name:RUGGLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 SHELA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5782
Mailing Address - Country:US
Mailing Address - Phone:740-727-8101
Mailing Address - Fax:
Practice Address - Street 1:2017 SHELA BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5782
Practice Address - Country:US
Practice Address - Phone:740-727-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000291969Medicaid
OH0000037865Medicaid