1831503853 NPI number — GREENE MEMORIAL HOSPITAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831503853 NPI number — GREENE MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENE MEMORIAL HOSPITAL INC
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:
Provider Other Organization Name Type Code:
6
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:
1831503853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2024
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:
45342-3598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
937-522-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 DAYTON ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
YELLOW SPRINGS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45387-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-767-7291
Provider Business Practice Location Address Fax Number:
937-737-1302
Provider Enumeration Date:
06/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KO
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
KETTERING HEALTH CFO
Authorized Official Telephone Number:
937-395-8522

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 0144766 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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