Provider Demographics
NPI:1265549604
Name:CLARK COUNTY
Entity type:Organization
Organization Name:CLARK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:937-390-5600
Mailing Address - Street 1:529 E HOME RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2710
Mailing Address - Country:US
Mailing Address - Phone:937-390-5600
Mailing Address - Fax:937-390-5626
Practice Address - Street 1:529 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2710
Practice Address - Country:US
Practice Address - Phone:937-390-5600
Practice Address - Fax:937-390-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0679654Medicaid
OHFV91261Medicare ID - Type UnspecifiedFLU AND PNEUMONIA BILLING