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General NPI Number Information
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NPI Number | 1346419744
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Entity Type | Organization
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Legal Business Name | ONTARIO CHILDREN'S HEALTH
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 2003 W 4TH ST
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City | MANSFIELD
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State | OH
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Zip | 44906-1787
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Country | US
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Telephone | 419-529-6285
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Fax | 419-529-3150
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Provider Business Mailing Address
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Address Line | 2003 W 4TH ST
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City | MANSFIELD
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State | OH
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Zip | 44906-1787
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Country | US
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Telephone | 419-529-6285
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Fax | 419-529-3150
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. V. DIANA TIMPERMAN
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Credential | M.D.
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Telephone | 419-529-6285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35048163
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License Number State | OH
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