Provider Demographics
NPI:1447385570
Name:STOVER, GARRY B III
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:B
Last Name:STOVER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MT CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686
Mailing Address - Country:US
Mailing Address - Phone:740-245-9850
Mailing Address - Fax:740-245-9852
Practice Address - Street 1:2001 MT CARMEL RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686
Practice Address - Country:US
Practice Address - Phone:740-245-9850
Practice Address - Fax:740-245-9852
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2547159Medicaid