Provider Demographics
NPI:1194775700
Name:SALEM COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SALEM COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HACKSTEDDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-332-7214
Mailing Address - Street 1:1995 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460
Mailing Address - Country:US
Mailing Address - Phone:330-337-9922
Mailing Address - Fax:330-332-2623
Practice Address - Street 1:2235 E PERSHING ST
Practice Address - Street 2:SUITE G
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-337-9922
Practice Address - Fax:330-332-2623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0827734Medicaid
OH360185Medicare Oscar/Certification
OH0533770001Medicare NSC