Provider Demographics
NPI:1629180401
Name:KIMBERLY S. UMHOEFER DO INC
Entity Type:Organization
Organization Name:KIMBERLY S. UMHOEFER DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:UMHOEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-355-8930
Mailing Address - Street 1:1729 KINNEYS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3165
Mailing Address - Country:US
Mailing Address - Phone:740-355-8930
Mailing Address - Fax:740-354-2936
Practice Address - Street 1:1729 KINNEYS LN
Practice Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36278546300OtherWORKERS COMP
P00174556OtherRAILROAD MEDICARE
OH362785463012OtherMEDICAL MUTUAL
OH000000337972OtherBCBS
OH2119326Medicaid
OH36278546300OtherWORKERS COMP
G93773Medicare UPIN