Basic Information
Provider Information | |||||||||
NPI: | 1871606921 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE UNION HOSPITAL ASSOCIATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UNION HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 659 BOULEVARD | ||||||||
Address2: |   | ||||||||
City: | DOVER | ||||||||
State: | OH | ||||||||
PostalCode: | 446222026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303433311 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 659 BOULEVARD | ||||||||
Address2: |   | ||||||||
City: | DOVER | ||||||||
State: | OH | ||||||||
PostalCode: | 446222026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303433311 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/15/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LONGVILLE | ||||||||
AuthorizedOfficialFirstName: | TIM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF ACCOUNTING OFFICER AND CONTRO | ||||||||
AuthorizedOfficialTelephone: | 2166367416 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | III | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/23/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X |   | OH | Y |   | Hospitals | General Acute Care Hospital | Rural |
ID Information
ID | Type | State | Issuer | Description | 1493320 | 01 | OH | UMWA PROVIDER# | OTHER | 6460630 | 01 | OH | AETNA PROVIDER # | OTHER | 000000186077 | 01 | OH | BC/BS PROVIDER # | OTHER | 8957759 | 05 | OH |   | MEDICAID |