Provider Demographics
NPI:1568566289
Name:HOLMES COUNTY GENERAL HEALTH DISTRICT
Entity Type:Organization
Organization Name:HOLMES COUNTY GENERAL HEALTH DISTRICT
Other - Org Name:COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:330-674-5035
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-0272
Mailing Address - Country:US
Mailing Address - Phone:330-674-5035
Mailing Address - Fax:330-674-2528
Practice Address - Street 1:85 N GRANT ST STE B
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:330-674-5035
Practice Address - Fax:330-674-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0980078Medicaid
OH0980078Medicaid