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General NPI Number Information
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NPI Number | 1699107763
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Entity Type | Organization
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Legal Business Name | OHIO ADVANCED HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 158 CHELSEA CV
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City | ZANESVILLE
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State | OH
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Zip | 43701-0812
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Country | US
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Telephone | 740-923-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 158 CHELSEA CV
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City | ZANESVILLE
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State | OH
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Zip | 43701-0812
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Country | US
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Telephone | 740-923-5050
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Fax |
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | DAVID RICHARD HARTSOCK
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Credential | BA
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Telephone | 740-586-3272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34007216
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License Number State | OH
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