Provider Demographics
NPI:1659638518
Name:FISHER TITUS MEDICAL CENTER
Entity Type:Organization
Organization Name:FISHER TITUS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITEHURST
Authorized Official - Suffix:II
Authorized Official - Credentials:ATC
Authorized Official - Phone:419-744-0929
Mailing Address - Street 1:272 BENEDICT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2374
Mailing Address - Country:US
Mailing Address - Phone:419-668-8101
Mailing Address - Fax:
Practice Address - Street 1:272 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:419-668-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.003664261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation