Healthcare Provider Details

I. General information

NPI: 1760450951
Provider Name (Legal Business Name): PAULDING COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W WAYNE ST
PAULDING OH
45879-1544
US

IV. Provider business mailing address

1035 W WAYNE ST
PAULDING OH
45879-1544
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-4080
  • Fax: 419-399-1147
Mailing address:
  • Phone: 419-399-4080
  • Fax: 419-399-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number275N00000X
License Number StateOH

VIII. Authorized Official

Name: RONALD H GOEDDE
Title or Position: CEO
Credential:
Phone: 419-399-1103