Provider Demographics
NPI:1497202857
Name:AULTMAN HOSPITAL
Entity Type:Organization
Organization Name:AULTMAN HOSPITAL
Other - Org Name:AULTWORKS OCCUPATIONAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-491-9675
Mailing Address - Street 1:4650 HILLS AND DALES ROAD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-6221
Mailing Address - Country:US
Mailing Address - Phone:330-491-9675
Mailing Address - Fax:330-491-1682
Practice Address - Street 1:4650 HILLS AND DALES ROAD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-6221
Practice Address - Country:US
Practice Address - Phone:330-491-9675
Practice Address - Fax:330-491-1682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AULTMAN HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty