Active NPI
Greene Memorial Hospital Services, Inc
- Obstetrics & Gynecology Physician
- Beavercreek, OH
National Provider Identifier
1083990394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- Legal business name
- GREENE MEMORIAL HOSPITAL SERVICES, INC
- Practice address
- 3535 Pentagon Blvd
Suite 220
Beavercreek, OH 45431-1705 - Phone
- (937) 429-7350
- Fax
- (937) 431-2623
- NPI assigned
- Nov 1, 2011
- Organization subpart
- Yes
- Parent organization
- GREENE MEMORIAL HOSPITAL SERVICES, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Timothy Y Ko
- Title
- Cfo
- Phone
- (937) 558-3208
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | Primary |
Addresses
Primary practice location
3535 Pentagon Blvd
Suite 220
Beavercreek, OH 45431-1705
Mailing address
10050 Innovation Dr
Suite 200
Miamisburg, OH 45342-4931
Phone (937) 558-3208
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0059473 | Medicaid | OH |
Other names 1
- Advanced Women's Healthcare
National Provider Directory
National Provider Directory- Part of
- Greene Memorial Hosp SE
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1404086400000",
"number": "1083990394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10050 INNOVATION DR",
"address_2": "SUITE 200",
"city": "MIAMISBURG",
"state": "OH",
"postal_code": "453424931",
"telephone_number": "937-558-3208",
"fax_number": "937-558-3248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 PENTAGON BLVD",
"address_2": "SUITE 220",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454311705",
"telephone_number": "937-429-7350",
"fax_number": "937-431-2623"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GREENE MEMORIAL HOSPITAL SERVICES, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GREENE MEMORIAL HOSPITAL SERVICES, INC",
"enumeration_date": "2011-11-01",
"last_updated": "2014-06-30",
"status": "A",
"authorized_official_last_name": "KO",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "Y",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "937-558-3208"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0059473",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Women's Healthcare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Beavercreek, OH
- Greene Dental Associates
- Greene Memorial Hospital
- Greene Memorial Hospital
- Greene Memorial Hospital Services Inc
- Greene Memorial Hospital Services, Inc
- Greene Memorial Hospital Services, Inc
- Greene Memorial Hospital Services, Inc
- Greene Memorial Hospital Services, Inc
- Greene Memorial Hospital Services, Inc
- Greene Memorial Hospital Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.