Healthcare Provider Details

I. General information

NPI: 1093813537
Provider Name (Legal Business Name): HEALTHWORKS MED GROUP OF OHIO CORP., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CALDWELL ST
CHILLICOTHEE OH
45601-3332
US

IV. Provider business mailing address

16906 COLLECTION CENTER DR
CHICAGO IL
60693-0169
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-3374
  • Fax: 740-775-6999
Mailing address:
  • Phone: 877-865-9013
  • Fax: 217-709-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE A BROOME
Title or Position: OWNER
Credential: M.D.
Phone: 615-468-6554