Provider Demographics
NPI:1821172776
Name:HEALTHWORKS MED GROUP OF OHIO CORP., P. A.
Entity Type:Organization
Organization Name:HEALTHWORKS MED GROUP OF OHIO CORP., P. A.
Other - Org Name:GOODYEAR FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-565-1733
Mailing Address - Street 1:40 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6155
Mailing Address - Country:US
Mailing Address - Phone:615-565-1733
Mailing Address - Fax:615-296-0151
Practice Address - Street 1:45 GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-4032
Practice Address - Country:US
Practice Address - Phone:330-796-0229
Practice Address - Fax:330-796-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9293241Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER