Basic Information
| Provider Information | |||||||||
| NPI: | 1154487478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. RITA'S MEDICAL CENTER FOR DISEASE MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 W. MARKET STREET | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965069 | ||||||||
| FaxNumber: | 4199965424 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 W MARKET ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458052799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965069 | ||||||||
| FaxNumber: | 4199965424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARROD | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4192269315 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.