=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629180401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMBERLY S. UMHOEFER DO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1729 KINNEYS LN SUITE 201
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-355-8930
-----------------------------------------------------
Fax | 740-354-2936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1729 KINNEYS LN SUITE 201
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-355-8930
-----------------------------------------------------
Fax | 740-354-2936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | KIMBERLY SUE UMHOEFER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 740-355-8930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 34-00-7109
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------