Basic Information
Provider Information
NPI: 1477150308
EntityType: 2
ReplacementNPI:  
OrganizationName: ORRVILLE HOSPITAL FOUNDATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 80690
Address2:  
City: CANTON
State: OH
PostalCode: 447080690
CountryCode: US
TelephoneNumber: 3304798705
FaxNumber: 3304799330
Practice Location
Address1: 603 MONROE ST
Address2:  
City: DOVER
State: OH
PostalCode: 446222046
CountryCode: US
TelephoneNumber: 3303648889
FaxNumber: 3303437505
Other Information
ProviderEnumerationDate: 10/05/2020
LastUpdateDate: 10/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LUNTZ
AuthorizedOfficialFirstName: ADAM
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3303633889
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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