Provider Demographics
NPI:1477688380
Name:COUNTY OF CLINTON
Entity Type:Organization
Organization Name:COUNTY OF CLINTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-382-7221
Mailing Address - Street 1:111 S NELSON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2067
Mailing Address - Country:US
Mailing Address - Phone:937-382-7221
Mailing Address - Fax:937-382-7027
Practice Address - Street 1:111 S NELSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2067
Practice Address - Country:US
Practice Address - Phone:937-382-7221
Practice Address - Fax:937-382-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274439Medicaid
OH0566696Medicaid
OH0566696Medicaid