Provider Demographics
NPI:1578289906
Name:HUMPHRIES, JOHN ISAAC
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ISAAC
Last Name:HUMPHRIES
Suffix:
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 1:25200 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1941
Mailing Address - Country:US
Mailing Address - Phone:216-308-1277
Mailing Address - Fax:
Practice Address - Street 1:25200 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1941
Practice Address - Country:US
Practice Address - Phone:216-308-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide