Basic Information
| Provider Information | |||||||||
| NPI: | 1992738959 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| 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 | ||||||||
| FaxNumber: | 4196636036 | ||||||||
| Practice Location | |||||||||
| Address1: | 272 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196688101 | ||||||||
| FaxNumber: | 4196636036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4196688101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 1204 | OH | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0435767 | 01 | OH | UMWA INPATIENT | OTHER | 05160 | 01 | OH | PARAMOUNT | OTHER | 2781502 | 05 | OH | MEDICAID | 0058557 | 01 | OH | AETNA | OTHER | 0530875 | 01 | OH | UMWA OUTPATIENT | OTHER | 000000157564 | 01 | OH | ANTHEM | OTHER |