Provider Demographics
| NPI: | 1467492975 |
|---|---|
| Name: | ULTIMATE HEALTH SERVICES INC |
| Entity Type: | Organization |
| Organization Name: | ULTIMATE HEALTH SERVICES INC |
| Other - Org Name: | HUNTINGTON INTERNAL MEDICINE GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MARK |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | MORGAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 304-528-4600 |
| Mailing Address - Street 1: | 5170 US RT 60 EAST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HUNTINGTON |
| Mailing Address - State: | WV |
| Mailing Address - Zip Code: | 25705 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 304-528-4600 |
| Mailing Address - Fax: | 304-697-0856 |
| Practice Address - Street 1: | 5170 US RT 60 EAST |
| Practice Address - Street 2: | |
| Practice Address - City: | HUNTINGTON |
| Practice Address - State: | WV |
| Practice Address - Zip Code: | 25705 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 304-528-4600 |
| Practice Address - Fax: | 304-697-0856 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-07 |
| Last Update Date: | 2020-01-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 2412124 | Medicaid | |
| OH | 2492100 | Medicaid | |
| OH | 2412115 | Medicaid | |
| OH | 2412133 | Medicaid | |
| KY | 65938573 | Medicaid | |
| 51C0001015 | Other | MEDICARE SUPPLIER ID/ AFC | |
| WV | 0011539000 | Medicaid | |
| OH | 2492100 | Medicaid | |
| KY | 65938573 | Medicaid | |
| KY | 7185 | Medicare PIN | |
| 51C0001015 | Other | MEDICARE SUPPLIER ID/ AFC | |
| 9331661 | Medicare PIN |
