1154487478 NPI number — ST. RITA'S MEDICAL CENTER FOR DISEASE MANAGEMENT

Table of content: (NPI 1154487478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154487478 NPI number — ST. RITA'S MEDICAL CENTER FOR DISEASE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. RITA'S MEDICAL CENTER FOR DISEASE MANAGEMENT
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:
1154487478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 W. MARKET STREET
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-996-5069
Provider Business Mailing Address Fax Number:
419-996-5424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-2799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-996-5069
Provider Business Practice Location Address Fax Number:
419-996-5424
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARROD
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
419-226-9315

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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