Basic Information
| Provider Information | |||||||||
| NPI: | 1942267760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAN WERT COUNTY HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | VAN WERT HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | VAN WERT HEALTH | ||||||||
| Address2: | 1250 S WASHINGTON ST | ||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192382390 | ||||||||
| FaxNumber: | 4192380692 | ||||||||
| Practice Location | |||||||||
| Address1: | VAN WERT HEALTH | ||||||||
| Address2: | 1250 S WASHINGTON ST | ||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192382390 | ||||||||
| FaxNumber: | 4192380692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SILALAHI | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4192388870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ========= | 01 | OH | WORKMEN COMPENSATION PHY. | OTHER | 3600711 | 01 | OH | MEDICARE CARRIER PROVIDER | OTHER | ========= | 01 | OH | WORKMENS COMPENSATION HOS | OTHER | CK1277 | 01 | OH | MEDICARE RAILROAD | OTHER | ========= | 01 | OH | MEDICAL MUTUAL PHYSICIAN | OTHER | 000000184281 | 01 | OH | ANTHEM HOSPITAL PROVIDER | OTHER | 9027663 | 05 | OH | MEDICAID | ========= | 01 | OH | MEDICAL MUTUAL HOSPITAL | OTHER | 000000030033 | 01 | OH | ANTHEM PHYSICIAN BILLING | OTHER |