Provider Demographics
NPI:1891763876
Name:LICKING COUNTY
Entity Type:Organization
Organization Name:LICKING COUNTY
Other - Org Name:LICKING COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RS, MS, MBA
Authorized Official - Phone:740-349-6535
Mailing Address - Street 1:675 PRICE RD NE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9454
Mailing Address - Country:US
Mailing Address - Phone:740-349-6535
Mailing Address - Fax:740-349-6935
Practice Address - Street 1:675 PRICE RD NE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9454
Practice Address - Country:US
Practice Address - Phone:740-349-6535
Practice Address - Fax:740-349-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-2030-M251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291670Medicaid
OH600001195OtherRAILROAD MEDICARE
OHFV90771OtherMT.CARMEL HEALTH-MEDIGOLD
OHFV90771Medicare PIN