Provider Demographics
NPI:1508239161
Name:MCCULLOUGH HYDE MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:MCCULLOUGH HYDE MEMORIAL HOSPITAL INC
Other - Org Name:MCCULLOUGH HYDE CAMDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYLWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-6302
Mailing Address - Street 1:79 W CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-1007
Mailing Address - Country:US
Mailing Address - Phone:937-452-6051
Mailing Address - Fax:
Practice Address - Street 1:79 W CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-1007
Practice Address - Country:US
Practice Address - Phone:937-452-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory