1124062419 NPI number — WASHINGTON COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1124062419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124062419 NPI number — WASHINGTON COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON 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:
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:
1124062419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 N. SHELBY ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47167-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-883-5881
Provider Business Mailing Address Fax Number:
812-883-8557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 N. SHELBY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47167-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-883-5881
Provider Business Practice Location Address Fax Number:
812-883-8557
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROCHE
Authorized Official First Name:
JOE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
81288635881

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 0050871 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 07-005087-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200009980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054337 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100269720 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030969400 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100269720A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200009980F , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 940950 . This is a "MEDICARE PART B" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100367960A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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