Provider Demographics
NPI:1831503853
Name:GREENE MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:GREENE MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:KETTERING HEALTH CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-8522
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:888 DAYTON ST
Practice Address - Street 2:STE 200
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1777
Practice Address - Country:US
Practice Address - Phone:937-767-7291
Practice Address - Fax:937-737-1302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144766Medicaid
OH0144766Medicaid