Provider Demographics
NPI:1235548090
Name:FISHER-TITUS AFFILIATED SERVICES
Entity Type:Organization
Organization Name:FISHER-TITUS AFFILIATED SERVICES
Other - Org Name:NORTH CENTRAL MOBILE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-660-6931
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-0399
Mailing Address - Country:US
Mailing Address - Phone:419-663-1367
Mailing Address - Fax:419-499-2664
Practice Address - Street 1:12513 US HIGHWAY 250 N
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9546
Practice Address - Country:US
Practice Address - Phone:419-663-1367
Practice Address - Fax:419-499-2664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISHER-TITUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH275490Medicare PIN