Provider Demographics
NPI:1720056575
Name:PAULDING COUNTY
Entity type:Organization
Organization Name:PAULDING COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-399-3921
Mailing Address - Street 1:800 E PERRY STREET
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1403
Mailing Address - Country:US
Mailing Address - Phone:419-399-3921
Mailing Address - Fax:419-399-3494
Practice Address - Street 1:800 EAST PERRY STREET
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1403
Practice Address - Country:US
Practice Address - Phone:419-399-3921
Practice Address - Fax:419-399-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0624499Medicaid
OHFV90621Medicare PIN