Provider Demographics
NPI:1801051008
Name:LACP ST RITAS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:LACP ST RITAS MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-226-9103
Mailing Address - Street 1:708 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4661
Mailing Address - Country:US
Mailing Address - Phone:419-224-4075
Mailing Address - Fax:
Practice Address - Street 1:708 W SPRING ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4661
Practice Address - Country:US
Practice Address - Phone:419-224-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPPLIED FOR3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00644168OtherMEDICARE RAILROAD
OH2915626Medicaid
P00644168OtherMEDICARE RAILROAD