Healthcare Provider Details

I. General information

NPI: 1376780379
Provider Name (Legal Business Name): FIRELANDS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 PROGRESS DRIVE SUITE A
BELLEVUE OH
44811
US

IV. Provider business mailing address

290 PROGRESS DRIVE SUITE A
BELLEVUE OH
44811
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-2070
  • Fax: 419-483-2120
Mailing address:
  • Phone: 419-483-2070
  • Fax: 419-483-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN RILEY
Title or Position: CFO
Credential:
Phone: 419-557-7490