Provider Demographics
NPI:1912608373
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:MANAGER, RURAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIBDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-5400
Mailing Address - Street 1:601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-1662
Mailing Address - Country:US
Mailing Address - Phone:330-362-4799
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43968-1662
Practice Address - Country:US
Practice Address - Phone:330-362-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE FOUNDATION - COSHOCTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care