Provider Demographics
NPI:1902037765
Name:HOLY FAMILY MEDICAL PRACTICE
Entity Type:Organization
Organization Name:HOLY FAMILY MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STARRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-537-9277
Mailing Address - Street 1:4325 POST RD SE
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:OH
Mailing Address - Zip Code:43986-9620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1369 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1025
Practice Address - Country:US
Practice Address - Phone:740-537-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062644-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty