Healthcare Provider Details

I. General information

NPI: 1831250307
Provider Name (Legal Business Name): MORGAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 N SR376 NW
MCCONNELSVILLE OH
43756
US

IV. Provider business mailing address

4275 N SR376 NW
MCCONNELSVILLE OH
43756
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-4572
  • Fax:
Mailing address:
  • Phone: 740-962-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D0860081
License Number StateOH

VIII. Authorized Official

Name: DR. RICHARD D CLARK
Title or Position: HEALTH COMMISSIONER
Credential: M.D.
Phone: 740-962-4572