Provider Demographics
NPI:1164702148
Name:MONTGOMERY COUNTY COURTHOUSE
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY COURTHOUSE
Other - Org Name:PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY - BCMH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:937-225-5700
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:2ND FLOOR FSO
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45422-3000
Mailing Address - Country:US
Mailing Address - Phone:937-225-4543
Mailing Address - Fax:937-496-3318
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:2ND FLOOR FSO
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45422-3000
Practice Address - Country:US
Practice Address - Phone:937-225-5721
Practice Address - Fax:937-496-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local