Provider Demographics
NPI:1083990394
Name:GREENE MEMORIAL HOSPITAL SERVICES, INC
Entity Type:Organization
Organization Name:GREENE MEMORIAL HOSPITAL SERVICES, INC
Other - Org Name:ADVANCED WOMEN'S HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-558-3208
Mailing Address - Street 1:10050 INNOVATION DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4931
Mailing Address - Country:US
Mailing Address - Phone:937-558-3208
Mailing Address - Fax:937-558-3248
Practice Address - Street 1:3535 PENTAGON BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-429-7350
Practice Address - Fax:937-431-2623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE MEMORIAL HOSPITAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059473Medicaid
OH9273677Medicare PIN