Provider Demographics
NPI:1114024569
Name:CLARK COUNTY SHERIFF'S OFFICE
Entity type:Organization
Organization Name:CLARK COUNTY SHERIFF'S OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SHERIFF
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-328-2526
Mailing Address - Street 1:120 N FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-1119
Mailing Address - Country:US
Mailing Address - Phone:937-328-2526
Mailing Address - Fax:937-328-2515
Practice Address - Street 1:3130 E. NATIONAL RD.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505
Practice Address - Country:US
Practice Address - Phone:937-328-2663
Practice Address - Fax:937-328-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare