Basic Information
Provider Information | |||||||||
NPI: | 1740384858 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OHIO HILLS HEALTH SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OHIO HILLS HEALTH CENTER WOODSFIELD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | BARNESVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 437131005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402396447 | ||||||||
FaxNumber: | 7404720283 | ||||||||
Practice Location | |||||||||
Address1: | 584 LEWISVILLE RD | ||||||||
Address2: |   | ||||||||
City: | WOODSFIELD | ||||||||
State: | OH | ||||||||
PostalCode: | 437939227 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402396447 | ||||||||
FaxNumber: | 7404720283 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/11/2006 | ||||||||
LastUpdateDate: | 11/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRITTON | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7402396447 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | OHIO HILLS HEALTH SERVICES | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X |   | OH | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
ID | Type | State | Issuer | Description | 2824546 | 05 | OH |   | MEDICAID | OH3618291 | 01 | OH | MEDICARE FQHC PIN | OTHER |