Provider Demographics
NPI:1497483127
Name:PRIME HEALTHCARE FOUNDATION - COSHOCTON LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE FOUNDATION - COSHOCTON LLC
Other - Org Name:COSHOCTON REGIONAL MEDICAL CENTER WARSAW CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-4706
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-6450
Mailing Address - Country:US
Mailing Address - Phone:740-824-3568
Mailing Address - Fax:
Practice Address - Street 1:221 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9659
Practice Address - Country:US
Practice Address - Phone:740-824-3568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health