Provider Demographics
NPI:1144210634
Name:SMITHVILLE WESTERN INC.
Entity Type:Organization
Organization Name:SMITHVILLE WESTERN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CIO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5234
Mailing Address - Street 1:4110 E SMITHVILLE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7782
Mailing Address - Country:US
Mailing Address - Phone:330-345-9050
Mailing Address - Fax:330-345-9212
Practice Address - Street 1:4110 E SMITHVILLE WESTERN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7782
Practice Address - Country:US
Practice Address - Phone:330-345-9050
Practice Address - Fax:330-345-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6141314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000357109OtherANTHEM OT
OH2265329Medicaid
OH000000156569OtherANTHEM
OH000000357106OtherANTHEM PT
OH000000357110OtherANTHEM ST
OH=========002OtherMEDICAL MUTUAL
OH365317Medicare ID - Type UnspecifiedADMINASTAR
OH000000357106OtherANTHEM PT
OH000000357110OtherANTHEM ST