Provider Demographics
NPI:1053398099
Name:COSHOCTON COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:COSHOCTON COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-623-4138
Mailing Address - Street 1:1460 ORANGE ST
Mailing Address - Street 2:P.O. BOX 1330
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2229
Mailing Address - Country:US
Mailing Address - Phone:740-622-6411
Mailing Address - Fax:
Practice Address - Street 1:1460 ORANGE ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2229
Practice Address - Country:US
Practice Address - Phone:740-622-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1129282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1793340Medicaid
OH6460550OtherAETNA
OH000000156950OtherANTHEM
OH5000017OtherUNITED HEALTHCARE
OH1793340OtherBUREAU CHILDREN MED HAND
OH000000156950OtherANTHEM
OH1793340OtherBUREAU CHILDREN MED HAND
OH1793340Medicaid