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General NPI Number Information
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NPI Number | 1053454314
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Entity Type | Organization
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Legal Business Name | VAN WERT MEDICAL SERVICES
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 506 S MAIN ST
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City | ROCKFORD
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State | OH
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Zip | 45882-9228
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Country | US
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Telephone | 419-363-3008
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Fax | 419-363-2093
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Provider Business Mailing Address
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Address Line | 1250 S WASHINGTON ST
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City | VAN WERT
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State | OH
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Zip | 45891-2551
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Country | US
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Telephone | 419-232-5279
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Fax | 419-238-0692
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLY KAY SUTTON
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Credential |
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Telephone | 419-363-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 398291
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License Number State | OH
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