Provider Demographics
NPI:1124018585
Name:SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:WILSON MEMORIAL BEHAVIORAL HEALTH UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COVAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-498-5402
Mailing Address - Street 1:915 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-498-2311
Mailing Address - Fax:937-498-5527
Practice Address - Street 1:915 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-2311
Practice Address - Fax:937-498-5527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
36S013Medicare Oscar/Certification