Provider Demographics
NPI:1891829768
Name:RITTMAN FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:RITTMAN FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WIDMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-925-3857
Mailing Address - Street 1:25 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1914
Mailing Address - Country:US
Mailing Address - Phone:330-925-3857
Mailing Address - Fax:330-925-4016
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1914
Practice Address - Country:US
Practice Address - Phone:330-925-3857
Practice Address - Fax:330-925-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071171W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2076999Medicaid
OHRI4036361Medicare ID - Type Unspecified
OH2076999Medicaid