Provider Demographics
NPI:1760249528
Name:RUTH, MARK R
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:RUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 COTTONTAIL CT
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8406
Mailing Address - Country:US
Mailing Address - Phone:440-477-8000
Mailing Address - Fax:
Practice Address - Street 1:1628 COTTONTAIL CT
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-8406
Practice Address - Country:US
Practice Address - Phone:440-477-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS982165342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company