Organization
HLES OF OHIO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MOORE (CFO)
(415) 435-4591
Entity
Organization
Contact information
Practice address
725 S SHOOP AVE, WAUSEON, OH 43567-1702
(800) 998-7578
Mailing address
PO BOX 936429, ATLANTA, GA 31193-6429
(800) 377-8721
(304) 697-1155
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679806301
—
MI
05
—
2991786
—
OH
01
—
DP8339
RR MEDICARE
—
Enumeration date
09/14/2009
Last updated
03/30/2018
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