Provider Demographics
NPI:1083897987
Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Entity Type:Organization
Organization Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Other - Org Name:POMERENE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-674-1015
Mailing Address - Street 1:981 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1536
Mailing Address - Country:US
Mailing Address - Phone:330-674-1584
Mailing Address - Fax:330-674-9314
Practice Address - Street 1:1261 WOOSTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1568
Practice Address - Country:US
Practice Address - Phone:330-674-2822
Practice Address - Fax:330-763-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2806477Medicaid
OH9369171Medicare PIN