Provider Demographics
NPI:1437982493
Name:PEARSON MEDICAL SERVICES
Entity type:Organization
Organization Name:PEARSON MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASHMERE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:330-219-1619
Mailing Address - Street 1:24865 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9189
Mailing Address - Country:US
Mailing Address - Phone:614-500-3910
Mailing Address - Fax:
Practice Address - Street 1:24865 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9189
Practice Address - Country:US
Practice Address - Phone:614-500-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARSON MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1013588086Medicaid
KS1194783472Medicaid