Provider Demographics
NPI:1346338688
Name:COUNTY OF PREBLE
Entity Type:Organization
Organization Name:COUNTY OF PREBLE
Other - Org Name:PREBLE COUNTY GENERAL HEALTH DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-472-0087
Mailing Address - Street 1:615 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-8559
Mailing Address - Country:US
Mailing Address - Phone:937-472-0087
Mailing Address - Fax:937-456-6382
Practice Address - Street 1:615 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8559
Practice Address - Country:US
Practice Address - Phone:937-472-0087
Practice Address - Fax:937-456-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0980194Medicaid
OH0980164Medicaid
FV92211Medicare PIN