Provider Demographics
NPI:1225140007
Name:UMHOEFER, KIMBERLY SUE (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:UMHOEFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:1729 KINNEYS LN
Practice Address - Street 2:STE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3165
Practice Address - Country:US
Practice Address - Phone:740-355-8930
Practice Address - Fax:740-354-2936
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00174556OtherRAILROAD MEDICARE
OH2119326Medicaid
OH000000337972OtherBC BS
OH4043714Medicare ID - Type Unspecified
OH2119326Medicaid