Provider Demographics
NPI:1013468172
Name:PRIME HEALTHCARE FOUNDATION - COSHOCTON, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE FOUNDATION - COSHOCTON, LLC
Other - Org Name:
Other - Org Type:
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:740-622-6411
Mailing Address - Fax:740-622-1283
Practice Address - Street 1:1460 ORANGE ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2229
Practice Address - Country:US
Practice Address - Phone:740-622-6411
Practice Address - Fax:740-622-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
OH1129282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty