Healthcare Provider Details

I. General information

NPI: 1932485265
Provider Name (Legal Business Name): GREENE MEMORIAL HOSPITAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CEREAL AVE SUITE 207
HAMILTON OH
45013-2784
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3660
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-3331
  • Fax: 513-867-2667
Mailing address:
  • Phone: 937-384-4838
  • Fax: 937-384-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL D HAIBACH
Title or Position: DIRECTOR BUSINESS DEVELOPMENT
Credential:
Phone: 937-558-3222