Provider Demographics
NPI:1043380454
Name:MIAMI VALLEY HOSPITAL
Entity Type:Organization
Organization Name:MIAMI VALLEY HOSPITAL
Other - Org Name:MIAMI VALLEY HOSPITAL - REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-2530
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-8000
Mailing Address - Fax:937-499-7813
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-8000
Practice Address - Fax:937-499-7813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5935608Medicaid
OH36T051Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER