Healthcare Provider Details

I. General information

NPI: 1275981185
Provider Name (Legal Business Name): HEALTH ONE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4079 GANTZ RD STE B
GROVE CITY OH
43123-4913
US

IV. Provider business mailing address

PO BOX 638
JOHNSTOWN OH
43031-0638
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-3444
  • Fax: 614-947-1324
Mailing address:
  • Phone: 614-947-1320
  • Fax: 614-594-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EUGENE M BOMGARDNER
Title or Position: CEO
Credential:
Phone: 614-947-1320