Provider Demographics
NPI:1235135054
Name:CITY OF COSHOCTON
Entity Type:Organization
Organization Name:CITY OF COSHOCTON
Other - Org Name:COSHOCTON CITY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:740-622-1736
Mailing Address - Street 1:400 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2044
Mailing Address - Country:US
Mailing Address - Phone:740-622-1736
Mailing Address - Fax:740-623-4559
Practice Address - Street 1:400 BROWNS LN
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2044
Practice Address - Country:US
Practice Address - Phone:740-622-1736
Practice Address - Fax:740-623-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2728436Medicaid
OHFV91621Medicare ID - Type UnspecifiedMEDICARE B
OH2728436Medicaid