Provider Demographics
NPI:1891744843
Name:PAULDING COUNTY HOSPITAL PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:PAULDING COUNTY HOSPITAL PHYSICIAN SERVICES
Other - Org Name:PCH PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JEANISE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-399-1104
Mailing Address - Street 1:1032 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1545
Mailing Address - Country:US
Mailing Address - Phone:419-399-1104
Mailing Address - Fax:419-399-5560
Practice Address - Street 1:1032 W. WAYNE ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1545
Practice Address - Country:US
Practice Address - Phone:419-399-1104
Practice Address - Fax:419-399-5560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAULDING COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2113126Medicaid
9299274OtherPTAN