1730494840 NPI number — WABASH COUNTY HOSPITAL, INC.

Table of content: (NPI 1730494840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730494840 NPI number — WABASH COUNTY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WABASH COUNTY 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:
FAMILY PHYSICIANS ASSOCIATED
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:
1730494840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 MANCHESTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WABASH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46992-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-563-7421
Provider Business Mailing Address Fax Number:
260-563-7725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 MANCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WABASH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46992-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-563-7421
Provider Business Practice Location Address Fax Number:
260-563-7725
Provider Enumeration Date:
08/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BISSEL
Authorized Official First Name:
JANE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
260-569-2247

Provider Taxonomy Codes

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

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

  • Identifier: 100270190 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".