1528097391 NPI number — HENRY COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1528097391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528097391 NPI number — HENRY COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY COUNTY MEMORIAL 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:
Provider Other Organization Name Type Code:
6
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:
1528097391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6081 E. 82ND ST.
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-570-0266
Provider Business Mailing Address Fax Number:
317-570-0488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46750-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-356-4867
Provider Business Practice Location Address Fax Number:
260-359-9087
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RING
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
765-521-1515

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-000346-1 , 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: 100288320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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