Provider Demographics
NPI:1518119791
Name:FAYETTE COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:FAYETTE COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-333-2507
Mailing Address - Street 1:1450 COLUMBUS AVE
Mailing Address - Street 2:SUITE B 6-7-8
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-3701
Mailing Address - Country:US
Mailing Address - Phone:740-333-2236
Mailing Address - Fax:740-333-3881
Practice Address - Street 1:1430 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1703
Practice Address - Country:US
Practice Address - Phone:740-333-2705
Practice Address - Fax:740-333-2998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAYETTE COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2941204Medicaid
OH2941204Medicaid