=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639174204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 MICHIGAN ST
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-498-2311
-----------------------------------------------------
Fax | 937-498-5527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 MICHIGAN ST
-----------------------------------------------------
City | SIDNEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45365-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-498-2311
-----------------------------------------------------
Fax | 937-498-5527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCIAL SERVICE
-----------------------------------------------------
Name | JULIE A COVAULT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-498-5402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 93701
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------