MEDICARE: MEMORIAL HOSPITAL OF GENEVA

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000268968	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164519831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPITAL OF GENEVA

Provider Business Mailing Address
First Line	:	5700 DARROW RD
Second Line	:	SUITE 106
City	:	HUDSON
State	:	OH
Zip	:	44236-5026
Country	:	US
Telephone Number	:	330-656-5911
Fax Number	:	330-656-5901

Provider Business Practice Location Address
First Line	:	870 W MAIN ST
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-1219
Country	:	US
Telephone Number	:	440-415-0159
Fax Number	:	330-656-5901

Authorized Official
Title or Position	:	CEO
Name	:	LORI ANDERSON-PRINTY
Credential	:
Telephone Number	:	330-656-5911

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	06/11/2008

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Directions to “MEMORIAL HOSPITAL OF GENEVA ” Practice Location

Language	Start Address	Practice Location

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