1205844495 NPI number — WHITLEY MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1205844495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205844495 NPI number — WHITLEY MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITLEY MEMORIAL HOSPITAL, 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:
PARKVIEW WHITLEY HOSPITAL
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:
1205844495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46895-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-373-7008
Provider Business Mailing Address Fax Number:
260-373-7059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 E STATE ROAD 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-248-9302
Provider Business Practice Location Address Fax Number:
260-248-9107
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKENS
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP -- CFO
Authorized Official Telephone Number:
260-266-9313

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  06-005090-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000098126 . This is a "INDIANA COMP. ID#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 9422664 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4744 . This is a "PHP IDENTIFICATION #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 03697300 . This is a "BLACK LUNG ID#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1509946 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100268830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304608369 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000004969 . This is a "MPLAN IDENTIFICATION #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01300664 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351965665-001 . This is a "CHAMPUS IDENTIFICATION #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000098126 . This is a "ANTHEM IDENTIFICATION #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 404608378 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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