Healthcare Provider Details

I. General information

NPI: 1831525500
Provider Name (Legal Business Name): MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MORNING SUN RD STE A PINNACLE ORTHOPAEDICS & SPORTS MEDICINE
OXFORD OH
45056-9546
US

IV. Provider business mailing address

110 N POPLAR ST PINNACLE ORTHOPAEDICS & SPORTS MEDICINE
OXFORD OH
45056-1204
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-1100
  • Fax:
Mailing address:
  • Phone: 513-523-2111
  • Fax: 513-524-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN D. HEHEMANN
Title or Position: PRESIDENT & CEO
Credential: FACHE, CEO
Phone: 513-524-5501