MEDICARE: GREENE MEMORIAL HOSPITAL SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063798395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE MEMORIAL HOSPITAL SERVICES, INC

Provider Business Mailing Address
First Line	:	2110 LEITER RD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3660
Country	:	US
Telephone Number	:	937-384-4838
Fax Number	:	937-384-4845

Provider Business Practice Location Address
First Line	:	1145 CHANNINGWAY DR
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-9244
Country	:	US
Telephone Number	:	937-878-8644
Fax Number	:	937-878-8646

Authorized Official
Title or Position	:	DIRECTOR BUSINESS DEVELOPMENT
Name	:	DANIEL D HAIBACH
Credential	:
Telephone Number	:	937-558-3222

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	03/08/2012

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