Provider Demographics
NPI:1104865245
Name:POOLE, JOSEPH V I (AIDE,CARE GIVER)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:V
Last Name:POOLE
Suffix:I
Gender:M
Credentials:AIDE,CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 MAPLE BENNER RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8831
Mailing Address - Country:US
Mailing Address - Phone:740-353-2305
Mailing Address - Fax:
Practice Address - Street 1:2076A MAPLE BENNER RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8831
Practice Address - Country:US
Practice Address - Phone:740-353-2305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2451789171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2451789Medicaid