1578569588 NPI number — LIMA MEMORIAL JOINT OPERATING COMPANY

Table of content: (NPI 1578569588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578569588 NPI number — LIMA MEMORIAL JOINT OPERATING COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIMA MEMORIAL JOINT OPERATING COMPANY
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:
LIMA MEMORIAL HEALTH SYSTEM
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:
1578569588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BELLEFONTAINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45804-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-226-5165
Provider Business Mailing Address Fax Number:
419-226-5128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BELLEFONTAINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-226-5165
Provider Business Practice Location Address Fax Number:
419-226-5128
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POHJALA
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
419-226-5163

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000174124 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0021501 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5184518 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05199 . This is a "PARAMOUNT" identifier . This identifiers is of the category "OTHER".




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