Healthcare Provider Details

I. General information

NPI: 1467702142
Provider Name (Legal Business Name): A. JOHN TURJOMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 OHIO RIVER RD
WHEELERSBURG OH
45694-1922
US

IV. Provider business mailing address

8930 OHIO RIVER RD
WHEELERSBURG OH
45694-1922
US

V. Phone/Fax

Practice location:
  • Phone: 740-574-1903
  • Fax: 740-574-0784
Mailing address:
  • Phone: 740-574-1903
  • Fax: 740-574-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35082095
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number35082095
License Number StateOH

VIII. Authorized Official

Name: MS. MICHELLE ANN HANCOCK
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 515-528-8312