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General NPI Number Information
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NPI Number | 1255734711
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Entity Type | Organization
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Legal Business Name | JEFFERSON COUNTY FOURTH STREET HEALTH CENTER
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1 ROSS PARK BLVD STE 202 380 SUMMIT AVENUE
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2671
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Country | US
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Telephone | 740-283-2856
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ROSS PARK BLVD STE 202 380 SUMMIT AVENUE
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2671
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Country | US
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Telephone | 740-283-2856
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANN QUILLEN
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Credential |
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Telephone | 740-283-2856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AN1558329
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License Number State | OH
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