Healthcare Provider Details

I. General information

NPI: 1073781597
Provider Name (Legal Business Name): HOSPITAL MEDICINE SERVICES OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W MARION RD
MOUNT GILEAD OH
43338-1027
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-5015
  • Fax: 865-291-3254
Mailing address:
  • Phone: 856-686-4316
  • Fax: 865-291-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA L DOLLISON
Title or Position: OWNER
Credential: D.O.
Phone: 856-686-4304