Healthcare Provider Details

I. General information

NPI: 1619910486
Provider Name (Legal Business Name): WADSWORTH RITTMAN HOSPITAL PROFESSIONAL SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 WADSWORTH RD 301 FOUNDERS HALL
WADSWORTH OH
44281-9504
US

IV. Provider business mailing address

195 WADSWORTH RD
WADSWORTH OH
44281-9504
US

V. Phone/Fax

Practice location:
  • Phone: 330-331-1810
  • Fax: 330-331-1941
Mailing address:
  • Phone: 330-331-1498
  • Fax: 330-334-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY COLETTI
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-334-2946