1528068665 NPI number — DEFIANCE REGIONAL MEDICAL CENTER

Table of content: (NPI 1528068665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528068665 NPI number — DEFIANCE REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEFIANCE REGIONAL MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1528068665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 632927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-477-4035
Provider Business Mailing Address Fax Number:
419-882-1352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 RALSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-477-4035
Provider Business Practice Location Address Fax Number:
419-882-1352
Provider Enumeration Date:
07/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WACHSMAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP
Authorized Official Telephone Number:
419-824-7580

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  1160 , 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: 2079503 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".