MEDICARE: JAMES R HAYWARD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34002691H	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000198892	OTHER	OH	UNISON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0100639	OTHER	OH	UHC
4	000000120791	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1235133091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R HAYWARD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-0228
Country	:	US
Telephone Number	:	740-380-8068
Fax Number	:	740-380-2734

Provider Business Practice Location Address
First Line	:	819 STATE ROUTE 664 N
Second Line	:	STE A
City	:	LOGAN
State	:	OH
Zip	:	43138-8540
Country	:	US
Telephone Number	:	740-385-9614
Fax Number	:	740-380-2734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/23/2012

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