Healthcare Provider Details

I. General information

NPI: 1285770800
Provider Name (Legal Business Name): COUNTY WIDE HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 STATE ROUTE 93
IRONTON OH
45638-8358
US

IV. Provider business mailing address

4282 STATE ROUTE 93
IRONTON OH
45638-8358
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-7246
  • Fax: 740-532-8410
Mailing address:
  • Phone: 740-532-7246
  • Fax: 740-532-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number200423803440
License Number StateOH

VIII. Authorized Official

Name: MR. JAMES RICHARD BILLITER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 740-532-7246