Provider Demographics
NPI:1043438138
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:COMMUNITY MEMORIAL HOSPITAL-SW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:419-542-5564
Mailing Address - Street 1:208 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1250
Mailing Address - Country:US
Mailing Address - Phone:419-542-5564
Mailing Address - Fax:419-542-6506
Practice Address - Street 1:208 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1250
Practice Address - Country:US
Practice Address - Phone:419-542-5564
Practice Address - Fax:419-542-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36Z301Medicare Oscar/Certification