1083881312 NPI number — IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

Table of content: (NPI 1083881312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083881312 NPI number — IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHESAPEAKE FAMILY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083881312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 N 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45638-1578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-532-3534
Provider Business Mailing Address Fax Number:
740-532-0027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45619-1080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-867-6687
Provider Business Practice Location Address Fax Number:
740-867-5555
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR HEALTH SERVICES
Authorized Official Telephone Number:
740-532-3534

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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