Provider Demographics
NPI:1760799415
Name:SOUTHERN OHIO MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHERN OHIO MEDICAL CENTER
Other - Org Name:SOMC CANCER CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LSW/MSW
Authorized Official - Phone:740-356-7461
Mailing Address - Street 1:8635 STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-9000
Mailing Address - Country:US
Mailing Address - Phone:740-354-2989
Mailing Address - Fax:740-356-7488
Practice Address - Street 1:1121 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2806
Practice Address - Country:US
Practice Address - Phone:740-356-7461
Practice Address - Fax:740-356-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0700732282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural