Provider Demographics
NPI:1386699197
Name:SELBY GENERAL HOSPITAL
Entity type:Organization
Organization Name:SELBY GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-568-2000
Mailing Address - Street 1:1106 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1323
Mailing Address - Country:US
Mailing Address - Phone:740-568-2048
Mailing Address - Fax:740-568-2094
Practice Address - Street 1:1106 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-568-2040
Practice Address - Fax:740-568-2089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELBY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7943257Medicaid
WV0001482000Medicaid
36Z319Medicare ID - Type Unspecified