Provider Demographics
NPI:1831525500
Name:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEHEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, CEO
Authorized Official - Phone:513-524-5501
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-523-2111
Mailing Address - Fax:513-524-5665
Practice Address - Street 1:5151 MORNING SUN RD STE A
Practice Address - Street 2:PINNACLE ORTHOPAEDICS & SPORTS MEDICINE
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9546
Practice Address - Country:US
Practice Address - Phone:513-524-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-25
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
36OtherCHOICECARE
=========OtherCHAMPUS
=========001OtherCARESOURCE
=========OtherUNITED HEALTHCARE
=========-012OtherMEDICAL MUTUAL
OH5710707Medicaid
000000002696OtherANTHEM
0065681OtherAETNA
OH360046Medicare Oscar/Certification
=========OtherNATIONWIDE
=========00OtherWORKERS COMP
OH3600461Medicare PIN