Provider Demographics
NPI:1720609217
Name:WILLGLOWE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:WILLGLOWE HEALTH SERVICES, INC
Other - Org Name:WILLGLOWE INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-200-1791
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-0165
Mailing Address - Country:US
Mailing Address - Phone:330-361-0329
Mailing Address - Fax:
Practice Address - Street 1:2201 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-9997
Practice Address - Country:US
Practice Address - Phone:330-361-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty