Healthcare Provider Details

I. General information

NPI: 1891763876
Provider Name (Legal Business Name): LICKING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 PRICE RD NE
NEWARK OH
43055-9454
US

IV. Provider business mailing address

675 PRICE RD NE
NEWARK OH
43055-9454
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-6535
  • Fax: 740-349-6510
Mailing address:
  • Phone: 740-349-6535
  • Fax: 740-349-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number35-04-2030-M
License Number StateOH

VIII. Authorized Official

Name: MR. R. JOSEPH EBEL
Title or Position: HEALTH COMMISSIONER
Credential: R.S, M.S, M.B.A
Phone: 740-349-6535