Provider Demographics
NPI:1245454966
Name:COUNTY OF LOGAN OFFICE OF AUDITOR
Entity type:Organization
Organization Name:COUNTY OF LOGAN OFFICE OF AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-592-9040
Mailing Address - Street 1:310 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1720
Mailing Address - Country:US
Mailing Address - Phone:937-592-9040
Mailing Address - Fax:937-592-6746
Practice Address - Street 1:310 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1720
Practice Address - Country:US
Practice Address - Phone:937-592-9040
Practice Address - Fax:937-592-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0269043Medicaid
OHFV91601Medicare ID - Type UnspecifiedPROVIDER NUMBER
OH0269043Medicaid