Provider Demographics
NPI:1124312392
Name:VENUS WITTENAUER, D.O., INC
Entity type:Organization
Organization Name:VENUS WITTENAUER, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-426-3578
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-0489
Mailing Address - Country:US
Mailing Address - Phone:330-426-3578
Mailing Address - Fax:330-426-2458
Practice Address - Street 1:1517 N MARKET ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-1153
Practice Address - Country:US
Practice Address - Phone:330-426-3578
Practice Address - Fax:330-426-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006914M261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2076524Medicaid
OHG82075Medicare UPIN
OH2076524Medicaid