Basic Information
| Provider Information | |||||||||
| NPI: | 1871534677 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OHIO HILLS HEALTH SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OHIO HILLS HEALTH CENTER WOODSFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BARNESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437131005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402396447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 584 LEWISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WOODSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437939227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402396447 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| 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 | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0824237 | 05 | OH | MEDICAID | OH3618291 | 01 | OH | MEDICARE FQHC PIN | OTHER |