Healthcare Provider Details

I. General information

NPI: 1053344119
Provider Name (Legal Business Name): MC HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 8TH ST NE
MASSILLON OH
44646-8503
US

IV. Provider business mailing address

14117 COLLECTIONS CENTER DR
CHICAGO IL
60693
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-8761
  • Fax: 330-837-6871
Mailing address:
  • Phone: 330-832-8761
  • Fax: 330-837-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3558
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1272
License Number StateOH

VIII. Authorized Official

Name: DEBBIE BREWER
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 877-892-9813