Provider Demographics
NPI:1093813537
Name:HEALTHWORKS MED GROUP OF OHIO CORP., P.A.
Entity Type:Organization
Organization Name:HEALTHWORKS MED GROUP OF OHIO CORP., P.A.
Other - Org Name:GLATFELTER FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-468-6554
Mailing Address - Street 1:16906 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0169
Mailing Address - Country:US
Mailing Address - Phone:877-865-9013
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:311 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3332
Practice Address - Country:US
Practice Address - Phone:740-773-3374
Practice Address - Fax:740-775-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHE9294901Medicare ID - Type UnspecifiedGROUP NUMBER