1063447167 NPI number — FORT HAMILTON HOSPITAL

Table of content: (NPI 1063447167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063447167 NPI number — FORT HAMILTON HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT HAMILTON HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE FORT HAMILTON HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063447167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 LEITER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-3660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-914-7601
Provider Business Mailing Address Fax Number:
937-522-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 EATON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-585-8069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOTELLING
Authorized Official First Name:
DANN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
937-762-1644

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  1117 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016142002 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9126813 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016142002 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01884633 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01540145 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2875330 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3600132 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372243 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40 4642389 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431930200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP32617 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154913105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4181204 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: HXSP42617 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000472337X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100275840A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30 4642370 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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