Healthcare Provider Details

I. General information

NPI: 1124018585
Provider Name (Legal Business Name): SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MICHIGAN ST
SIDNEY OH
45365-2401
US

IV. Provider business mailing address

915 MICHIGAN ST
SIDNEY OH
45365-2401
US

V. Phone/Fax

Practice location:
  • Phone: 937-498-2311
  • Fax: 937-498-5527
Mailing address:
  • Phone: 937-498-2311
  • Fax: 937-498-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JULIE A COVAULT
Title or Position: VP FINANCIAL SERVICE
Credential:
Phone: 937-498-5402