Provider Demographics
NPI:1093869513
Name:CLINTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLINTON MEMORIAL HOSPITAL
Other - Org Name:CMH PROGRESSIVE CARE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-382-6611
Mailing Address - Street 1:610 W MAIN ST
Mailing Address - Street 2:P.O. BOX 600
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2125
Mailing Address - Country:US
Mailing Address - Phone:937-382-6611
Mailing Address - Fax:937-382-6633
Practice Address - Street 1:610 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2125
Practice Address - Country:US
Practice Address - Phone:937-382-6611
Practice Address - Fax:937-382-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-6089Medicare ID - Type UnspecifiedPROVIDER NUMBER