Healthcare Provider Details

I. General information

NPI: 1437452976
Provider Name (Legal Business Name): MARY RUTAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E PALMER RD
BELLEFONTAINE OH
43311-2281
US

IV. Provider business mailing address

205 E PALMER RD
BELLEFONTAINE OH
43311-2281
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-4015
  • Fax:
Mailing address:
  • Phone: 937-592-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: AMANDA C. GOBLE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-592-4015