Provider Demographics
NPI:1205966777
Name:EDWARD M. HOBBS JR DO INC
Entity type:Organization
Organization Name:EDWARD M. HOBBS JR DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-799-9745
Mailing Address - Street 1:4321 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2721
Mailing Address - Country:US
Mailing Address - Phone:330-799-9745
Mailing Address - Fax:330-799-5167
Practice Address - Street 1:4321 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2721
Practice Address - Country:US
Practice Address - Phone:330-799-9745
Practice Address - Fax:330-799-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0292535Medicaid
OH0292535Medicaid