Provider Demographics
NPI:1538174388
Name:RICHLAND SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:RICHLAND SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-522-2833
Mailing Address - Street 1:215 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2260
Mailing Address - Country:US
Mailing Address - Phone:419-522-2833
Mailing Address - Fax:419-524-1619
Practice Address - Street 1:215 WOOD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2260
Practice Address - Country:US
Practice Address - Phone:419-522-2833
Practice Address - Fax:419-524-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0148496Medicaid
OH=========OtherMEDICAL MUTUAL OF OHIO
OH0148496Medicaid
OH=========OtherANTHEM