Healthcare Provider Details

I. General information

NPI: 1083713770
Provider Name (Legal Business Name): DEFIANCE REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 RALSTON AVE SUITE 105
DEFIANCE OH
43512-5311
US

IV. Provider business mailing address

1250 RALSTON AVE SUITE 105
DEFIANCE OH
43512-5311
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6805
  • Fax: 419-783-6804
Mailing address:
  • Phone: 419-783-6805
  • Fax: 419-783-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0004427
License Number StateOH

VIII. Authorized Official

Name: MRS. JEANNE M PEFFLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-783-6805