1114254190 NPI number — WOODLAWN HOSPITAL

Table of content: (NPI 1114254190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114254190 NPI number — WOODLAWN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAWN 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:
1114254190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46975-8931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-233-3141
Provider Business Mailing Address Fax Number:
574-223-5847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E DUNN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
49631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-857-5995
Provider Business Practice Location Address Fax Number:
574-223-5847
Provider Enumeration Date:
11/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KRAFT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
574-224-1118

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: 100269770D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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