Healthcare Provider Details

I. General information

NPI: 1093774242
Provider Name (Legal Business Name): WASHINGTON CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 MUSKINGUM DR
MARIETTA OH
45750
US

IV. Provider business mailing address

342 MUSKINGUM DR
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-2782
  • Fax: 740-376-5810
Mailing address:
  • Phone: 740-374-2782
  • Fax: 740-376-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN COURTNEY WITSCHEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-374-2782