Provider Demographics
NPI:1194770248
Name:COUNTY OF PUTNAM OFFICE OF AUDITOR
Entity type:Organization
Organization Name:COUNTY OF PUTNAM OFFICE OF AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-538-7315
Mailing Address - Street 1:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0727
Mailing Address - Country:US
Mailing Address - Phone:440-605-9117
Mailing Address - Fax:440-442-4443
Practice Address - Street 1:117 DR THATYE DRIVE
Practice Address - Street 2:
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848
Practice Address - Country:US
Practice Address - Phone:419-538-7315
Practice Address - Fax:419-538-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000156068OtherANTHEM BCBS
OH590012253OtherRAILROAD MEDICARE
OH0248244Medicaid
OH34640113700OtherBWC
OH0248244Medicaid