MEDICARE: HOPE OF JABEZ

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	261QM2500X	Medical Specialty Clinic/Center	34008410	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	:	1902354095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE OF JABEZ

Provider Business Mailing Address
First Line	:	4068 GANTZ RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4816
Country	:	US
Telephone Number	:	614-957-5268
Fax Number	:	614-957-5303

Provider Business Practice Location Address
First Line	:	4068 GANTZ RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4816
Country	:	US
Telephone Number	:	614-957-5268
Fax Number	:	614-957-5303

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIM R ROUTH
Credential	:	D.O.
Telephone Number	:	614-957-5268

Provider Enumeration Date	:	09/17/2016
Last Update Date	:	02/26/2017

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Directions to “HOPE OF JABEZ ” Practice Location

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