Provider Demographics
NPI:1073948774
Name:GREENE MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:GREENE MEMORIAL HOSPITAL INC
Other - Org Name:KETTERING HEALTH PRIMARY CARE, A SERVICE OF KETTERING HEALTH GREENE ME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NETWORK CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-8995
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 KYLE DR
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-9580
Practice Address - Country:US
Practice Address - Phone:937-766-2611
Practice Address - Fax:937-766-5558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-12
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0146442Medicaid
OH363400Medicare PIN