Provider Demographics
NPI:1679744775
Name:JAY LUGIBIHL, D.O., INC.
Entity type:Organization
Organization Name:JAY LUGIBIHL, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LUGIBIHL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-223-1547
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423-0195
Mailing Address - Country:US
Mailing Address - Phone:330-223-1547
Mailing Address - Fax:330-223-1911
Practice Address - Street 1:29627 STATE RT. 30
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423
Practice Address - Country:US
Practice Address - Phone:330-223-1547
Practice Address - Fax:330-223-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34. 003675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0764481Medicaid