Provider Demographics
NPI:1144332719
Name:HEALTHQUEST OF VERMILION, INC.
Entity type:Organization
Organization Name:HEALTHQUEST OF VERMILION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TOMSHACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-967-4226
Mailing Address - Street 1:4365 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2133
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-8715
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2963111N00000X
OH3032111N00000X
OH3492111N00000X
OH2961111N00000X
OH3086111N00000X
OHPT 8647174400000X
OHPT 06257174400000X
OHPT 08360174400000X
OHPT 011085174400000X
OH2074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000179328OtherMD/DC ANTHEM BC/BS GRP #
OH2535895Medicaid
OH2209149Medicaid
OH2209201Medicaid
OH000000218228OtherPT ANTHEM BC/BS GRP #
OHCH3581OtherRAILROAD MEDICARE GROUP #
OH2209149Medicaid