1124135504 NPI number — HARRISON COUNTY HOSPITAL

Table of content: (NPI 1124135504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124135504 NPI number — HARRISON COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISON 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:
HARRISON COUNTY HOSPITAL AT HOME CARE
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:
1124135504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORYDON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47112-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-738-4251
Provider Business Mailing Address Fax Number:
812-738-7833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 HOSPITAL DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORYDON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47112-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-738-4251
Provider Business Practice Location Address Fax Number:
812-738-7833
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUVAL
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
812-738-4251

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  05005073-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 06-004773-1 , 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: 100450350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100265910A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000000107924 . This is a "ANTHEM HOME HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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