Provider Demographics
NPI:1063447167
Name:FORT HAMILTON HOSPITAL
Entity type:Organization
Organization Name:FORT HAMILTON HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOTELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-762-1644
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-914-7601
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:630 EATON AVENUE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-585-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1117273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO016142002Medicaid
FL9126813 00Medicaid
LA016142002Medicaid
NY01884633Medicaid
KY01540145Medicaid
OH2875330Medicaid
NC3600132Medicaid
AZ372243Medicaid
MI40 4642389Medicaid
ME431930200Medicaid
CAXHSP32617Medicaid
AR154913105Medicaid
NJ4181204Medicaid
CAHXSP42617Medicaid
GA000472337XMedicaid
IN100275840AMedicaid
MI30 4642370Medicaid
MI30 4642370Medicaid
NC3600132Medicaid