1790761922 NPI number — ASHTABULA COUNTY MEDICAL CENTER

Table of content: (NPI 1790761922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790761922 NPI number — ASHTABULA COUNTY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHTABULA COUNTY 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:
GLENBEIGH HEALTH SOURCES
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:
1790761922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2863 STATE ROUTE 45 N
Provider Second Line Business Mailing Address:
P.O. BOX 298
Provider Business Mailing Address City Name:
ROCK CREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44084-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-563-3400
Provider Business Mailing Address Fax Number:
440-563-9363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2863 STATE ROUTE 45 N
Provider Second Line Business Practice Location Address:
P O BO 298
Provider Business Practice Location Address City Name:
ROCK CREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44084-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-563-3400
Provider Business Practice Location Address Fax Number:
440-563-9363
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
440-710-3204

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  6713 , 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)





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