Healthcare Provider Details

I. General information

NPI: 1780348185
Provider Name (Legal Business Name): FIRSTHAND HEALTH OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 08/23/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 2
CLEVELAND OH
44125-1979
US

IV. Provider business mailing address

524 BROADWAY FL 11
NEW YORK NY
10012-4471
US

V. Phone/Fax

Practice location:
  • Phone: 844-378-4263
  • Fax:
Mailing address:
  • Phone: 844-378-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOE PARKS
Title or Position: INCORPORATOR
Credential: MD
Phone: 573-864-8733