Healthcare Provider Details

I. General information

NPI: 1982107975
Provider Name (Legal Business Name): VAN WERT MEDICAL SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 TOWNE CENTER BLVD
VAN WERT OH
45891
US

IV. Provider business mailing address

1250 S WASHINGTON ST
VAN WERT OH
45891-2551
US

V. Phone/Fax

Practice location:
  • Phone: 419-238-2390
  • Fax:
Mailing address:
  • Phone: 419-232-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DAWN CULP
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 419-232-5279