Provider Demographics
NPI:1487921920
Name:WHOLE HEALTH MEDICAL GROUP OF OHIO PROF CORP
Entity type:Organization
Organization Name:WHOLE HEALTH MEDICAL GROUP OF OHIO PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-468-6548
Mailing Address - Street 1:16906 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0169
Mailing Address - Country:US
Mailing Address - Phone:877-865-9013
Mailing Address - Fax:513-748-3685
Practice Address - Street 1:11530 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1642
Practice Address - Country:US
Practice Address - Phone:513-530-4104
Practice Address - Fax:513-748-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care