Provider Demographics
NPI:1902904253
Name:AULTMAN HOSPITAL
Entity Type:Organization
Organization Name:AULTMAN HOSPITAL
Other - Org Name:AULTMAN INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:330-363-6352
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-363-1410
Mailing Address - Fax:330-363-2380
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-1410
Practice Address - Fax:330-363-2380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AULTMAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0207362003336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0926976Medicaid
OH2515760001Medicare ID - Type Unspecified