NPIMap

Organization Active NPI

Greene Memorial Hospital Services, LLC

Doing business as Congress Park Family Practice

  • Family Medicine Physician
  • Centerville, OH
National Provider Identifier
1710263041
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREENE MEMORIAL HOSPITAL SERVICES, LLC
Doing business as
Congress Park Family Practice
Practice address
979 Congress Park Dr
Centerville, OH 45459-4009
Phone
(937) 435-9013
Fax
(937) 435-1458
NPI assigned
Nov 1, 2011
Last updated
Nov 1, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
GREENE MEMORIAL HOSPITAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

979 Congress Park Dr
Centerville, OH 45459-4009

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2639630MedicaidOH

Other names 1

  • Congress Park Family Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Greene Memorial Hospita32 organizations share this tax ID, including this one
Part of
Greene Memorial Hospita

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": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1710263041",
    "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": "979 CONGRESS PARK DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594009",
            "telephone_number": "937-435-9013",
            "fax_number": "937-435-1458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE MEMORIAL HOSPITAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENE MEMORIAL HOSPITAL SERVICES, LLC",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-11-01",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2639630",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Congress Park Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.