Healthcare Provider Details

I. General information

NPI: 1780186403
Provider Name (Legal Business Name): RITA A CULWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N WESTERN AVE
SPRINGFIELD OH
45504-2719
US

IV. Provider business mailing address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505-2607
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-5300
  • Fax: 937-322-4900
Mailing address:
  • Phone: 937-328-5300
  • Fax: 937-322-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.162946
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: