Provider Demographics
NPI:1801994827
Name:HOCKING VALLEY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:HOCKING VALLEY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HEFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-385-7564
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-385-7564
Mailing Address - Fax:740-385-7566
Practice Address - Street 1:819 STATE ROUTE 664 N
Practice Address - Street 2:SUITE A & B
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8540
Practice Address - Country:US
Practice Address - Phone:740-385-0202
Practice Address - Fax:740-385-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208D00000X, 207X00000X, 208000000X, 2084P0800X, 208600000X, 207XX0005X, 363L00000X, 363AS0400X, 363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH023303500OtherBLACK LUNG
OH0261756Medicaid
OH023303500OtherBLACK LUNG