1144557406 NPI number — FISHER-TITUS AFFILIATED SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144557406 NPI number — FISHER-TITUS AFFILIATED SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISHER-TITUS AFFILIATED SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH CENTRAL MOBILE DIAGNOSTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144557406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12513 US HIGHWAY 250 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44846-9546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-663-1367
Provider Business Mailing Address Fax Number:
419-499-2664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12513 US HIGHWAY 250 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44846-9546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-663-1367
Provider Business Practice Location Address Fax Number:
419-499-2664
Provider Enumeration Date:
11/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SENIOR VP OPERATIONS
Authorized Official Telephone Number:
419-660-6931

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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