Organization
WARREN COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DUANE STANSBURY M. PH (HEALTH COMMISSIONER)
(513) 695-1566
Entity
Organization
Contact information
Practice address
416 S EAST ST, LEBANON, OH 45036-2378
(513) 695-1566
Mailing address
416 S EAST ST, LEBANON, OH 45036-2378
(513) 695-1566
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090229
MOLINA
OH
05
—
0980229
—
OH
01
—
14945
CARE SOURCE
OH
01
—
303363
AMERIGROUP
OH
Enumeration date
12/12/2006
Last updated
01/20/2012
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