Provider Demographics
NPI:1245216183
Name:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEHEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:513-524-5501
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-523-2111
Mailing Address - Fax:513-524-5665
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-523-2111
Practice Address - Fax:513-524-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000321430OtherANTHEM-REFERENCE LABORATO
KY01541978Medicaid
IN100275870Medicaid
IN200180950Medicaid
0068681OtherAETNA
000000002696OtherANTHEM-FACILITY
000000003325OtherANTHEM-PATHOLOGY
OH5710707Medicaid
35OtherCHOICECARE INPATIENT
36OtherCHOICE CARE OUTPATIENT
IN200180950Medicaid
KY01541978Medicaid
0068681OtherAETNA
IN100275870Medicaid
=========OtherCHAMPUS
OH5710707Medicaid