Basic Information
| Provider Information | |||||||||
| NPI: | 1245296532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER OF RITTMAN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RITTMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309254911 | ||||||||
| FaxNumber: | 3309279258 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RITTMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309254911 | ||||||||
| FaxNumber: | 3309279258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRACASSO | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ERNEST | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3309254911 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0748927 | 05 | OH | MEDICAID |