Basic Information
| Provider Information | |||||||||
| NPI: | 1962698951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS OHIO HEALTH CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2030 STRINGTOWN RD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431233993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145440167 | ||||||||
| FaxNumber: | 6145440176 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 STRINGTOWN RD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431233993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145440167 | ||||||||
| FaxNumber: | 6145440176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | TI LYNN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONAL DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 6145440167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2639827 | 05 | OH | MEDICAID | 2158203 | 05 | OH | MEDICAID | CB0331 | 01 | OH | RR MEDICARE | OTHER | 2201834 | 05 | OH | MEDICAID | 2639729 | 05 | OH | MEDICAID |