Healthcare Provider Details

I. General information

NPI: 1457384174
Provider Name (Legal Business Name): OHIO HOSPITAL-BASED PHYSICIAN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 WALES RD NE
MASSILLON OH
44646-4111
US

IV. Provider business mailing address

2600 SIXTH STREET SW
CANTON OH
44710
US

V. Phone/Fax

Practice location:
  • Phone: 330-834-1111
  • Fax:
Mailing address:
  • Phone: 330-452-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOH

VIII. Authorized Official

Name: FAITH BASTIC
Title or Position: VP
Credential:
Phone: 330-452-9911