Basic Information
| Provider Information | |||||||||
| NPI: | 1982107975 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAN WERT MEDICAL SERVICES, LTD. | ||||||||
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| OtherOrganizationName: | VAN WERT NORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192325279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 TOWNE CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192382390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2018 | ||||||||
| LastUpdateDate: | 03/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | CULP | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4192325279 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.