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General NPI Number Information
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NPI Number | 1720609217
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Entity Type | Organization
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Legal Business Name | WILLGLOWE HEALTH SERVICES, INC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 2201 E MAPLE ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-9997
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Country | US
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Telephone | 330-361-0329
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2165
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City | NORTH CANTON
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State | OH
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Zip | 44720-0165
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Country | US
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Telephone | 330-361-0329
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GLORIA J KOOMSON
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Credential | MD
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Telephone | 216-200-1791
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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 |
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License Number State |
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