Provider Demographics
NPI:1295940120
Name:CITY OF IRONTON
Entity type:Organization
Organization Name:CITY OF IRONTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCKFORD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-532-2172
Mailing Address - Street 1:2120 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2502
Mailing Address - Country:US
Mailing Address - Phone:740-532-2172
Mailing Address - Fax:740-532-4186
Practice Address - Street 1:2120 S 8TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2502
Practice Address - Country:US
Practice Address - Phone:740-532-2172
Practice Address - Fax:740-532-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE39180251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0253649Medicaid
OHE39180Medicare UPIN