Basic Information
Provider Information
NPI: 1063778827
EntityType: 2
ReplacementNPI:  
OrganizationName: GALION COMMUNITY HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GCH PHYSICIAN PRACTICE, NEW WASHINGTON CAMPUS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 269 PORTLAND WAY S
Address2:  
City: GALION
State: OH
PostalCode: 448332312
CountryCode: US
TelephoneNumber: 4194684841
FaxNumber:  
Practice Location
Address1: 120 W MAIN ST
Address2:  
City: NEW WASHINGTON
State: OH
PostalCode: 448549431
CountryCode: US
TelephoneNumber: 4194922200
FaxNumber: 4194922100
Other Information
ProviderEnumerationDate: 04/05/2012
LastUpdateDate: 03/27/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DRAIME
AuthorizedOfficialFirstName: DONALD
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: VICE PRESIDENT/CFO
AuthorizedOfficialTelephone: 4194680501
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


Home