Basic Information
| Provider Information | |||||||||
| NPI: | 1497962807 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARRISON COMMUNITY HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | CADIZ | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439079799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409424631 | ||||||||
| FaxNumber: | 7409422749 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | CADIZ | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439079799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409424631 | ||||||||
| FaxNumber: | 7409422749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | DEBLASIS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7409426201 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1022 | OH | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 2547686 | 05 | OH | MEDICAID | 000000184762 | 01 | OH | ANTHEM AMBULANCE | OTHER |