Provider Demographics
NPI:1174920102
Name:LICKING COUNTY COMMUNITY HEALTH CARE
Entity type:Organization
Organization Name:LICKING COUNTY COMMUNITY HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCARPITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-345-1613
Mailing Address - Street 1:144B W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5008
Mailing Address - Country:US
Mailing Address - Phone:740-345-1613
Mailing Address - Fax:740-349-0956
Practice Address - Street 1:144B W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5008
Practice Address - Country:US
Practice Address - Phone:740-345-1613
Practice Address - Fax:740-349-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045247261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center