Provider Demographics
NPI:1962458521
Name:COMMUNITY HOSPITALS AND WELLNESS CENTERS
Entity Type:Organization
Organization Name:COMMUNITY HOSPITALS AND WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-636-1131
Mailing Address - Street 1:433 W HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1679
Mailing Address - Country:US
Mailing Address - Phone:419-636-1131
Mailing Address - Fax:419-636-3100
Practice Address - Street 1:433 W HIGH STREET
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1679
Practice Address - Country:US
Practice Address - Phone:419-636-1131
Practice Address - Fax:419-636-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1254404Medicaid
MI1924697-IPMedicaid
OH000000157134OtherANTHEM BC BS
MI1924712-OPMedicaid
OH=========045OtherMEDICAL MUTUAL OF OHIO
MI1924697-IPMedicaid
OH000000157134OtherANTHEM BC BS
MI1924712-OPMedicaid