MAD RIVER FAMILY PRACTICE
NPI 1003875949
Family Medicine in West Liberty, OH

Q: What is the provider's specialty?

The provider's specialty is Family Medicine with taxonomy code 207Q00000X.

Active since March 20, 2006CLIA Certified · 2 labs

4879 US HIGHWAY 68 S, WEST LIBERTY, OH 43357(937) 599-1411(937) 465-9945 Get Directions Write a Review

NPPES record last updated: July 10, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Mad River Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAD RIVER FAMILY PRACTICE (NPI 1003875949) is a healthcare organization registered as a family medicine in West Liberty, Ohio and active in the NPI registry since March 2006. The organization holds 2 active CLIA laboratory certificates and lists Ron Carmin, Vp/finance, as its authorized official.

NPPES Registry Identity

NPI1003875949

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameMARY RUTAN HOSPITAL

Location Address4879 US HIGHWAY 68 SWest Liberty, OH 43357-9525

Mailing Address4879 Us Highway 68 SWest Liberty, OH 43357-9525 · (937) 599-1411 · Fax (937) 465-9945

Phone(937) 599-1411

Fax(937) 465-9945

Organization SubpartYes

Authorized OfficialRon CarminVp/finance · (937) 592-4015

Enumeration DateMarch 20, 2006

Last NPPES UpdateJuly 10, 2007

✔ NPI 1003875949 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4879 US HIGHWAY 68 S, West Liberty, OH 43357

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Other Names 1

Doing Business AsMad River Family Practice

Other Identifiers 2

Medicare ID-Type UnspecifiedMA9296981OH

Medicaid2055332OH

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 36D0667939

Mary Rutan Hospital Patient Services · Bellefontaine, OH

Active · expires Nov 30, 2027

CLIA Number36D0667939

Laboratory TypeHospital

Certificate Effective DateDecember 1, 2025

Certificate Expiration DateNovember 30, 2027

Laboratory DirectorDr. Scott Wendroth

Laboratory Phone(937) 592-4015

Laboratory LocationMary Rutan Hospital Patient Services205 East Palmer Road, Bellefontaine, OH 43311

CLIA data matches this NPI record on: Name Phone

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Accreditation 36D0330718

Mary Rutan Hospital Clinical Lab · Bellefontaine, OH

Active · expires Feb 8, 2027

CLIA Number36D0330718

Laboratory TypeHospital

Certificate Effective DateFebruary 9, 2025

Certificate Expiration DateFebruary 8, 2027

Laboratory DirectorDr. Scott M. Wendroth

Laboratory Phone(937) 592-4015

Laboratory LocationMary Rutan Hospital Clinical Lab205 Palmer Avenue, Bellefontaine, OH 43311

CLIA data matches this NPI record on: Name Phone

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RANDALL L LONGENECKER M.D.

Family Medicine