Provider Demographics
NPI:1437452976
Name:MARY RUTAN HOSPITAL
Entity Type:Organization
Organization Name:MARY RUTAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-592-4015
Mailing Address - Street 1:205 E PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2281
Mailing Address - Country:US
Mailing Address - Phone:937-592-4015
Mailing Address - Fax:
Practice Address - Street 1:205 E PALMER RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2281
Practice Address - Country:US
Practice Address - Phone:937-592-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY RUTAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-06
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit