Provider Demographics
NPI:1760450951
Name:PAULDING COUNTY HOSPITAL
Entity Type:Organization
Organization Name:PAULDING COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOEDDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-399-1103
Mailing Address - Street 1:1035 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1544
Mailing Address - Country:US
Mailing Address - Phone:419-399-4080
Mailing Address - Fax:419-399-1147
Practice Address - Street 1:1035 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1544
Practice Address - Country:US
Practice Address - Phone:419-399-4080
Practice Address - Fax:419-399-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH275N00000X275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36Z300Medicare Oscar/Certification