Provider Demographics
NPI:1982635744
Name:SOUTHERN OHIO MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHERN OHIO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-356-8540
Mailing Address - Street 1:1087 DENNISON AVE
Mailing Address - Street 2:4TH FLOOR WEST
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3201
Mailing Address - Country:US
Mailing Address - Phone:614-544-5696
Mailing Address - Fax:614-544-5820
Practice Address - Street 1:1805 27TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-356-8560
Practice Address - Fax:740-354-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7892571Medicaid
OH7892571Medicaid