Provider Demographics
NPI:1164411765
Name:EAST HOLMES FAMILY CARE INC
Entity Type:Organization
Organization Name:EAST HOLMES FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:KORNHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-893-3771
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610
Mailing Address - Country:US
Mailing Address - Phone:330-893-3771
Mailing Address - Fax:330-893-3770
Practice Address - Street 1:4907A DALBEY LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610
Practice Address - Country:US
Practice Address - Phone:330-893-3771
Practice Address - Fax:330-893-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0851369Medicaid
OH0851369Medicaid