=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205018348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUSKINGUM VALLEY HEALTH CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 06/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 859 NORTH MAIN ST.
-----------------------------------------------------
City | MALTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43758-9007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-962-6111
-----------------------------------------------------
Fax | 740-962-2182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 ADAIR AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-891-9000
-----------------------------------------------------
Fax | 740-891-9001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DANIEL J ATKINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-891-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------