1811910813 NPI number — AULTMAN HEALTH FOUNDATION

Table of content: (NPI 1811910813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811910813 NPI number — AULTMAN HEALTH FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AULTMAN HEALTH FOUNDATION
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:
6
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:
1811910813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 WALES AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-305-6999
Provider Business Mailing Address Fax Number:
330-830-5454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 WALES AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-305-6999
Provider Business Practice Location Address Fax Number:
330-830-5454
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONOUGH
Authorized Official First Name:
G SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
330-834-1111

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: CL.021021550-03 , 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: 2080381 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com