Provider Demographics
NPI:1467636399
Name:FISHER-TITUS MEDICAL CARE LLC
Entity Type:Organization
Organization Name:FISHER-TITUS MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, 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 1:272 BENEDICT AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:419-668-8101
Mailing Address - Fax:419-660-2686
Practice Address - Street 1:272 BENEDICT AVENUE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:419-668-8101
Practice Address - Fax:419-660-2686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISHER-TITUS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36D0946912OtherCLIA
OH2807109Medicaid
OHDG8412OtherMEDICARE RR
OHFT9373741Medicare PIN