Provider Demographics
NPI:1790716553
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:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-356-8847
Mailing Address - Street 1:2201 25TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3259
Mailing Address - Country:US
Mailing Address - Phone:740-356-7050
Mailing Address - Fax:740-356-7890
Practice Address - Street 1:2201 25TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3259
Practice Address - Country:US
Practice Address - Phone:740-356-5600
Practice Address - Fax:740-353-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050288Medicaid
OH367087Medicare ID - Type Unspecified