MEDICARE: NAMI OF CLARK COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1033312913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAMI OF CLARK COUNTY

Provider Business Mailing Address
First Line	:	224 EAST ST REAR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 EAST ST REAR
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1110
Country	:	US
Telephone Number	:	937-322-5600
Fax Number	:	937-325-1951

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	JASON WILLIAM SHERROCK
Credential	:
Telephone Number	:	937-360-4360

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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