Provider Demographics
NPI:1023289204
Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Entity type:Organization
Organization Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-674-1015
Mailing Address - Street 1:981 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1536
Mailing Address - Country:US
Mailing Address - Phone:330-674-1584
Mailing Address - Fax:330-763-2063
Practice Address - Street 1:4606 TOWNSHIP ROAD 634
Practice Address - Street 2:
Practice Address - City:MT. HOPE
Practice Address - State:OH
Practice Address - Zip Code:44660
Practice Address - Country:US
Practice Address - Phone:330-674-4711
Practice Address - Fax:330-674-3320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHE 9369171Medicare UPIN