Provider Demographics
NPI:1598936338
Name:WADSWORTH RITTMAN HOSPITAL PROFESSIONAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:WADSWORTH RITTMAN HOSPITAL PROFESSIONAL SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-331-1498
Mailing Address - Street 1:195 WADSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9504
Mailing Address - Country:US
Mailing Address - Phone:330-331-1498
Mailing Address - Fax:330-334-2946
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9504
Practice Address - Country:US
Practice Address - Phone:330-335-2005
Practice Address - Fax:330-334-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821281Medicaid
OHDE2885OtherRR MEDICARE
OHDE2885OtherRR MEDICARE