NPIMap

Organization Active NPI

Greene Memorial Hospital Services, LLC

Doing business as David J Ettinger, MD

  • Plastic Surgery Physician
  • Beavercreek, OH
National Provider Identifier
1689941403
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
GREENE MEMORIAL HOSPITAL SERVICES, LLC
Doing business as
David J Ettinger, MD
Practice address
3359 Kemp Rd
Suite 200
Beavercreek, OH 45431-2565
Phone
(937) 429-7307
Fax
(937) 429-7320
NPI assigned
Nov 22, 2011
Organization subpart
Yes
Parent organization
GREENE MEMORIAL HOSPITAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel D Haibach
Title
Director Business Development
Phone
(937) 558-3222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

3359 Kemp Rd
Suite 200
Beavercreek, OH 45431-2565

Mailing address

2110 Leiter Rd
Miamisburg, OH 45342-3660
Phone (937) 384-4838

Other identifiers 1

IdentifierTypeStateIssuer
2639630MedicaidOH

Other names 1

  • David J Ettinger, MD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Greene Mem Hosp Serv32 organizations share this tax ID, including this one
Part of
Greene Mem Hosp Serv

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1689941403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423660",
            "telephone_number": "937-384-4838",
            "fax_number": "937-384-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3359 KEMP RD",
            "address_2": "SUITE 200",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312565",
            "telephone_number": "937-429-7307",
            "fax_number": "937-429-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE MEMORIAL HOSPITAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENE MEMORIAL HOSPITAL SERVICES, LLC",
        "enumeration_date": "2011-11-22",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "HAIBACH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "937-558-3222"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2639630",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David J Ettinger, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.