Basic Information
| Provider Information | |||||||||
| NPI: | 1831525500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | PINNACLE ORTHOPEDICS & SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N POPLAR ST | ||||||||
| Address2: | PINNACLE ORTHOPAEDICS & SPORTS MEDICINE | ||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450561204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135232111 | ||||||||
| FaxNumber: | 5135245665 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 MORNING SUN RD STE A | ||||||||
| Address2: | PINNACLE ORTHOPAEDICS & SPORTS MEDICINE | ||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450569546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135241100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | HEHEMANN | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 5135245501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | FACHE, CEO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.