Healthcare Provider Details

I. General information

NPI: 1396732574
Provider Name (Legal Business Name): NOBLE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44069 MARIETTA RD
CALDWELL OH
43724-9124
US

IV. Provider business mailing address

44069 MARIETTA RD
CALDWELL OH
43724-9124
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-4958
  • Fax: 740-732-5043
Mailing address:
  • Phone: 740-732-4958
  • Fax: 740-732-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. SHAWN E RAY
Title or Position: HEALTH COMMISSIONER
Credential: RS, MPH
Phone: 740-732-4958