Healthcare Provider Details

I. General information

NPI: 1891744843
Provider Name (Legal Business Name): PAULDING COUNTY HOSPITAL PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 W. WAYNE ST
PAULDING OH
45879-1545
US

IV. Provider business mailing address

1032 W WAYNE ST
PAULDING OH
45879-1545
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-1104
  • Fax: 419-399-5560
Mailing address:
  • Phone: 419-399-1104
  • Fax: 419-399-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANISE DIANE DENNING
Title or Position: CREDENTIALING
Credential:
Phone: 419-399-1104