1518068881 NPI number — PUTNAM COUNTY HOSPITAL

Table of content: (NPI 1518068881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518068881 NPI number — PUTNAM COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUTNAM COUNTY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELWOOD HEALTH AND LIVING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518068881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1542 S. BLOOMINGTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENCASTLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46135-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-301-7525
Provider Business Mailing Address Fax Number:
765-301-7539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 PARKVIEW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46036-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-552-9884
Provider Business Practice Location Address Fax Number:
765-552-1304
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEATHERFORD
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
765-301-7300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060003721 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000098068 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100289060B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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