Provider Demographics
NPI:1346543881
Name:SUMMA BARBERTON HOSPITAL
Entity Type:Organization
Organization Name:SUMMA BARBERTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:EGERT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:330-807-8828
Mailing Address - Street 1:155 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:330-807-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid
OH=========Medicaid
OH=========Medicare PIN
OH=========Medicare UPIN