Healthcare Provider Details

I. General information

NPI: 1811910813
Provider Name (Legal Business Name): AULTMAN HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 WALES AVE NW
MASSILLON OH
44646
US

IV. Provider business mailing address

2021 WALES AVE NW
MASSILLON OH
44646
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-6999
  • Fax: 330-830-5454
Mailing address:
  • Phone: 330-305-6999
  • Fax: 330-830-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCL.021021550-03
License Number StateOH

VIII. Authorized Official

Name: G SCOTT MCDONOUGH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 330-834-1111