Provider Demographics
NPI:1164519831
Name:MEMORIAL HOSPITAL OF GENEVA
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF GENEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-PRINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-656-5911
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:870 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1219
Practice Address - Country:US
Practice Address - Phone:440-415-0159
Practice Address - Fax:330-656-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000268968OtherANTHEM
OH2347286Medicaid
OHCK5134Medicare PIN
OHME9329001Medicare UPIN