1558443077 NPI number — LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC

Table of content: (NPI 1558443077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558443077 NPI number — LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC
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:
MARTIN COUNTY HEALTH CENTER
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:
1558443077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47546-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-996-0299
Provider Business Mailing Address Fax Number:
812-996-8497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOALS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47581-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-247-2733
Provider Business Practice Location Address Fax Number:
812-247-2373
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
812-996-0507

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200298610A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB3118 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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