Basic Information
| Provider Information | |||||||||
| NPI: | 1659638518 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FISHER TITUS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196688101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 272 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196688101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2012 | ||||||||
| LastUpdateDate: | 04/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | WHITEHURST | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | STAFF ATHLETIC TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 4197440929 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | AT.003664 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.