Provider Demographics
NPI:1639139017
Name:JESUS C HONTANOSAS MD INC
Entity Type:Organization
Organization Name:JESUS C HONTANOSAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:HONTANOSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-732-1660
Mailing Address - Street 1:2055 HOSPITAL DR
Mailing Address - Street 2:STE 335
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1978
Mailing Address - Country:US
Mailing Address - Phone:513-732-1660
Mailing Address - Fax:513-732-1665
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:STE 335
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1978
Practice Address - Country:US
Practice Address - Phone:513-732-1660
Practice Address - Fax:513-732-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043368OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000010212OtherANTHEM
OH0405798Medicaid
OH0405798Medicaid
OHH00466703Medicare PIN