Provider Demographics
NPI:1386056331
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
Authorized Official - Phone:513-524-5501
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:MCCULLOUGH-HYDE RHEUMATOLOGY
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-524-5549
Mailing Address - Fax:
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:MCCULLOUGH-HYDE RHEUMATOLOGY
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-524-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCULLOUGH-HYDE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-27
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1119207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty