MEDICARE: GREENE MEMORIAL HOSPITAL 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	261QR1300X	Rural Health Clinic/Center		OH

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	:	1831503853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	2110 LEITER RD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3598
Country	:	US
Telephone Number	:
Fax Number	:	937-522-7685

Provider Business Practice Location Address
First Line	:	888 DAYTON ST
Second Line	:	STE 200
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1777
Country	:	US
Telephone Number	:	937-767-7291
Fax Number	:	937-737-1302

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

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	11/25/2024

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Directions to “GREENE MEMORIAL HOSPITAL INC ” Practice Location

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