Basic Information
Provider Information
NPI: 1346896875
EntityType: 2
ReplacementNPI:  
OrganizationName: FORT HAMILTON HOSPITAL
LastName:  
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Mailing Information
Address1: 2110 LEITER RD
Address2:  
City: MIAMISBURG
State: OH
PostalCode: 453423598
CountryCode: US
TelephoneNumber: 9373844506
FaxNumber: 9375227685
Practice Location
Address1: 630 EATON AVE
Address2:  
City: HAMILTON
State: OH
PostalCode: 45013
CountryCode: US
TelephoneNumber: 5138672000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/12/2019
LastUpdateDate: 04/06/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HOTELLING
AuthorizedOfficialFirstName: DANN
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: VICE PRESIDENT OF FINANCE
AuthorizedOfficialTelephone: 9377621644
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 04/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
273Y00000X  Y Hospital UnitsRehabilitation Unit 

No ID Information.


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