Healthcare Provider Details

I. General information

NPI: 1073798807
Provider Name (Legal Business Name): DEFIANCE REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RALSTON AVE
DEFIANCE OH
43512-1396
US

IV. Provider business mailing address

PO BOX 633762
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL KOENIG
Title or Position: CFO
Credential:
Phone: 419-783-6805