Healthcare Provider Details

I. General information

NPI: 1386699197
Provider Name (Legal Business Name): SELBY GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COLEGATE DR
MARIETTA OH
45750-1323
US

IV. Provider business mailing address

1106 COLEGATE DR
MARIETTA OH
45750-1323
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-2040
  • Fax: 740-568-2089
Mailing address:
  • Phone: 740-568-2048
  • Fax: 740-568-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PAIGE SMITH
Title or Position: PRESIDENT
Credential:
Phone: 740-568-2000