Provider Demographics
NPI:1144261520
Name:RICHARD B. OGLE DO INC
Entity type:Organization
Organization Name:RICHARD B. OGLE DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:34-002260
Authorized Official - Phone:740-397-3553
Mailing Address - Street 1:206 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3331
Mailing Address - Country:US
Mailing Address - Phone:740-397-3553
Mailing Address - Fax:740-392-4158
Practice Address - Street 1:206 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3331
Practice Address - Country:US
Practice Address - Phone:740-397-3553
Practice Address - Fax:740-392-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-002260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0248995Medicaid
OH0248995Medicaid
OHF45984Medicare UPIN