Provider Demographics
NPI:1194001420
Name:GREENE MEMORIAL HOSPITAL SERVICES, INC
Entity Type:Organization
Organization Name:GREENE MEMORIAL HOSPITAL SERVICES, INC
Other - Org Name:FT HAMILTON PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-558-3222
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-384-4838
Mailing Address - Fax:937-384-4845
Practice Address - Street 1:630 EATON AVE
Practice Address - Street 2:2 WEST
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-867-4169
Practice Address - Fax:513-867-7990
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:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2639630Medicaid
OH9273677Medicare PIN