Provider Demographics
NPI:1548254931
Name:MARY RUTAN HOSPITAL
Entity type:Organization
Organization Name:MARY RUTAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-592-4015
Mailing Address - Street 1:205 PALMER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2298
Mailing Address - Country:US
Mailing Address - Phone:937-592-4015
Mailing Address - Fax:
Practice Address - Street 1:205 PALMER AVENUE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2298
Practice Address - Country:US
Practice Address - Phone:937-592-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7607503Medicaid
OH7607503Medicaid
OH=========-00OtherBWC PROVIDER NUMBER
3601971Medicare Oscar/Certification