Basic Information
| Provider Information | |||||||||
| NPI: | 1407275696 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIXBY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIXBY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635239 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172650900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 818 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172650900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 04/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | STUDER | ||||||||
| AuthorizedOfficialFirstName: | HAYLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, ACUTE CARE & PPCS REVENUE | ||||||||
| AuthorizedOfficialTelephone: | 4198247576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.