Provider Demographics
NPI:1235300492
Name:WADSWORTH RITTMAN HOSPITAL PROFESSIONAL SERVIC
Entity Type:Organization
Organization Name:WADSWORTH RITTMAN HOSPITAL PROFESSIONAL SERVIC
Other - Org Name:BARBERTON AREA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURE/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-331-1042
Mailing Address - Street 1:195 WADSWORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281
Mailing Address - Country:US
Mailing Address - Phone:330-331-1093
Mailing Address - Fax:330-331-1906
Practice Address - Street 1:155 5TH STREET NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-615-3205
Practice Address - Fax:330-615-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE2885OtherRR MEDICARE
DE2885OtherRR MEDICAID
OH2644277Medicaid
9358141Medicare PIN