Provider Demographics
NPI:1215014113
Name:IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Entity Type:Organization
Organization Name:IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Other - Org Name:CHESAPEAKE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:740-532-3534
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-3534
Mailing Address - Fax:740-532-0027
Practice Address - Street 1:717 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1080
Practice Address - Country:US
Practice Address - Phone:740-867-6687
Practice Address - Fax:740-867-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0949308Medicaid
WV3810014070Medicaid
KY7100113390Medicaid
WI361851Medicare Oscar/Certification