=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124628094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AULTMAN HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2020
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2821 WOODLAWN AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44708-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-363-1410
-----------------------------------------------------
Fax | 330-363-2380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 80868
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44708-0868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-363-7444
-----------------------------------------------------
Fax | 330-363-7770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ADAM M LUNTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-363-3889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------