Provider Demographics
NPI:1740883222
Name:GOVERN, JOSEPH LEONARD
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEONARD
Last Name:GOVERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 N HIGH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2316
Mailing Address - Country:US
Mailing Address - Phone:614-888-5683
Mailing Address - Fax:614-888-9988
Practice Address - Street 1:7100 N HIGH ST STE 204
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2316
Practice Address - Country:US
Practice Address - Phone:614-888-5683
Practice Address - Fax:614-888-9988
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2467503Medicaid