Provider Demographics
NPI:1801904966
Name:FISHER-TITUS AFFILIATED SERVICES
Entity type:Organization
Organization Name:FISHER-TITUS AFFILIATED SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-660-6931
Mailing Address - Street 1:12513 US ROUTE 250
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846
Mailing Address - Country:US
Mailing Address - Phone:419-663-1367
Mailing Address - Fax:419-499-2664
Practice Address - Street 1:12513 US ROUTE 250
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846
Practice Address - Country:US
Practice Address - Phone:419-663-1367
Practice Address - Fax:419-499-2664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISHER-TITUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2200123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618022Medicaid
OH9216924Medicare ID - Type UnspecifiedSTA 8
OH000000155602Medicare UPIN
OH590003471Medicare ID - Type UnspecifiedRAILROAD
OH=========0007Medicare UPIN
OH9216921Medicare ID - Type UnspecifiedSTA. 2
OH0618022Medicaid
OH9216925Medicare ID - Type UnspecifiedSTA. 4
OH9216927Medicare ID - Type UnspecifiedSTA 5
OH9216929Medicare ID - Type UnspecifiedSTA 11
OH9216923Medicare ID - Type UnspecifiedSTA 6
OH9216926Medicare ID - Type UnspecifiedSTA 7
OH9331751Medicare ID - Type UnspecifiedSTA 9
OH9216928Medicare ID - Type UnspecifiedSTA 10