Healthcare Provider Details

I. General information

NPI: 1043438138
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COLUMBUS ST
HICKSVILLE OH
43526-1250
US

IV. Provider business mailing address

208 COLUMBUS ST
HICKSVILLE OH
43526-1250
US

V. Phone/Fax

Practice location:
  • Phone: 419-542-5564
  • Fax: 419-542-6506
Mailing address:
  • Phone: 419-542-5564
  • Fax: 419-542-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. SHARON MCGOWAN
Title or Position: VICE PRESIDENT FINANCE CFO
Credential: MBA
Phone: 419-542-5564