Basic Information
| Provider Information | |||||||||
| NPI: | 1962488411 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCCI HOSPITAL MANSFIELD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7333 NORTH FREEWAY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138078686 | ||||||||
| FaxNumber: | 7138078604 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 GLESSNER AVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195260777 | ||||||||
| FaxNumber: | 4195260929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LANFORD | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT QUALITY & COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 7138078686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 1426 | OH | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 2143504 | 05 | OH | MEDICAID | 000000322141 | 01 | OH | BLUE CROSS | OTHER |