Provider Demographics
NPI:1821279936
Name:MEMORIAL HOSPITAL OF UNION COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF UNION COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUBBS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:937-644-6115
Mailing Address - Street 1:500 LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5512
Mailing Address - Country:US
Mailing Address - Phone:937-578-4043
Mailing Address - Fax:
Practice Address - Street 1:17853 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9609
Practice Address - Country:US
Practice Address - Phone:937-578-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083208207R00000X
OH35054531207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871978Medicaid
OH9372061Medicare PIN