Basic Information
| Provider Information | |||||||||
| NPI: | 1194396218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRADY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 561 W CENTRAL AVE | ||||||||
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| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430151489 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 OHIO HEALTH BLVD | ||||||||
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| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430158900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406150227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2021 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROWNING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 6145444161 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GRADY MEMORIAL HOSPITAL | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
No ID Information.