Provider Demographics
NPI:1730145392
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:MARK, MILFORD, HICKSVILLE JOINT TOWNSHIP HOSPITAL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-542-5566
Mailing Address - Street 1:208 COLUMBUS STREET
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526
Mailing Address - Country:US
Mailing Address - Phone:419-542-6692
Mailing Address - Fax:419-542-6506
Practice Address - Street 1:208 COLUMBUS STREET
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526
Practice Address - Country:US
Practice Address - Phone:419-542-6692
Practice Address - Fax:419-542-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1677841Medicaid
361301Medicare Oscar/Certification
36Z301Medicare Oscar/Certification
361301Medicare PIN