MEDICARE: IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

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	261QD0000X	Dental Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1225386501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION

Provider Business Mailing Address
First Line	:	305 N 5TH ST
Second Line	:
City	:	IRONTON
State	:	OH
Zip	:	45638-1578
Country	:	US
Telephone Number	:	740-532-3534
Fax Number	:

Provider Business Practice Location Address
First Line	:	13804 STATE ROUTE 141
Second Line	:
City	:	KITTS HILL
State	:	OH
Zip	:	45645-8848
Country	:	US
Telephone Number	:	740-643-2082
Fax Number	:	740-643-2126

Authorized Official
Title or Position	:	CEO
Name	:	DONALD R GOSSETT
Credential	:
Telephone Number	:	740-532-3534

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	12/15/2025

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1770839276 — IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
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