Provider Demographics
NPI:1417263997
Name:EHW PROFESSIONAL SERVICES, PLLC
Entity Type:Organization
Organization Name:EHW PROFESSIONAL SERVICES, PLLC
Other - Org Name:DOCTORS EXPRESS #2301
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOLLEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-522-0535
Mailing Address - Street 1:2208 PENTLAND RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5359
Mailing Address - Country:US
Mailing Address - Phone:813-390-2203
Mailing Address - Fax:850-248-2225
Practice Address - Street 1:109 W 23RD ST
Practice Address - Street 2:SUITE N 5
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7610
Practice Address - Country:US
Practice Address - Phone:813-390-2203
Practice Address - Fax:850-248-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care