Healthcare Provider Details

I. General information

NPI: 1689712879
Provider Name (Legal Business Name): MARY RUTAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 DOWELL AVE
BELLEFONTAINE OH
43311-2305
US

IV. Provider business mailing address

114 DOWELL AVE
BELLEFONTAINE OH
43311-2305
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-1099
  • Fax:
Mailing address:
  • Phone: 937-592-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD CARMIN
Title or Position: VP, FISCAL SERVICES
Credential:
Phone: 937-592-4015