Basic Information
| Provider Information | |||||||||
| NPI: | 1740520147 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEFIANCE HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DEFIANCE REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 632927 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452632927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194783069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 RALSTON AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435121396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197836955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2013 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | WACHSMAN | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP MANAGED CARE REIBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4198247577 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 236890 | OH | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.