Basic Information
| Provider Information | |||||||||
| NPI: | 1912184045 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OHIOHEALTH CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS HEALTH CORPORATION OF NELSONVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 MOUNT SAINT MARYS DR | ||||||||
| Address2: | |||||||||
| City: | NELSONVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457641280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407531931 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1950 MOUNT SAINT MARYS DR | ||||||||
| Address2: | |||||||||
| City: | NELSONVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457641280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407531931 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | SWART | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7407537301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.