Provider Demographics
NPI:1639133002
Name:JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL
Other - Org Name:JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-394-3387
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-394-3335
Mailing Address - Fax:419-394-8485
Practice Address - Street 1:200 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2400
Practice Address - Country:US
Practice Address - Phone:419-394-3335
Practice Address - Fax:419-394-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282N00000X
OHHOS0206236503336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131541OtherPK
OHJ03600323OtherMEDICARE ID
3679884OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH4434508Medicaid
3679884OtherNCPDP PROVIDER IDENTIFICATION NUMBER