Provider Demographics
NPI:1174862676
Name:SOUTHERN OHIO MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHERN OHIO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-356-8540
Mailing Address - Street 1:207 PLUMMERS LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7683
Mailing Address - Country:US
Mailing Address - Phone:606-796-0056
Mailing Address - Fax:606-796-0059
Practice Address - Street 1:207 PLUMMERS LN
Practice Address - Street 2:SUITE 12
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-7683
Practice Address - Country:US
Practice Address - Phone:606-796-0056
Practice Address - Fax:606-796-0059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN OHIO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-05
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health