Provider Demographics
NPI:1790397784
Name:SOUTHERN OHIO MEDICAL CENTER
Entity type:Organization
Organization Name:SOUTHERN OHIO MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BUTTERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-356-6853
Mailing Address - Street 1:1805 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2640
Mailing Address - Country:US
Mailing Address - Phone:740-356-8060
Mailing Address - Fax:740-356-6393
Practice Address - Street 1:1805 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2640
Practice Address - Country:US
Practice Address - Phone:740-356-8060
Practice Address - Fax:740-356-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy