Provider Demographics
NPI:1831687953
Name:E KEVIN OHEA MD GENERAL FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:E KEVIN OHEA MD GENERAL FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:O'HEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-947-3377
Mailing Address - Street 1:697 MANILA ST
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-6505
Mailing Address - Country:US
Mailing Address - Phone:601-947-3377
Mailing Address - Fax:601-947-3380
Practice Address - Street 1:697 MANILA ST
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6505
Practice Address - Country:US
Practice Address - Phone:601-947-3377
Practice Address - Fax:601-947-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty