MEDICARE: HEALTH PROFESSIONALS OF HOLMES COUNTY, INC

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	208000000X	Pediatrics Physician		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700069606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH PROFESSIONALS OF HOLMES COUNTY, INC

Provider Business Mailing Address
First Line	:	1261 WOOSTER RD
Second Line	:	SUITE 200
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-1568
Country	:	US
Telephone Number	:	330-674-3333
Fax Number	:	330-763-2063

Provider Business Practice Location Address
First Line	:	1261 WOOSTER RD
Second Line	:	SUITE 200
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-1568
Country	:	US
Telephone Number	:	330-674-3333
Fax Number	:	330-674-4484

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JASON JUSTUS
Credential	:
Telephone Number	:	330-674-1015

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	07/21/2022

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