Healthcare Provider Details

I. General information

NPI: 1639401367
Provider Name (Legal Business Name): OHIO MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PARK AVE
IRONTON OH
45638-1529
US

IV. Provider business mailing address

901 PARK AVE
IRONTON OH
45638-1529
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-8888
  • Fax: 740-532-1796
Mailing address:
  • Phone: 740-532-8888
  • Fax: 740-532-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DONNA J CAUDILL
Title or Position: SECRETARY
Credential:
Phone: 606-796-0385