1316279755 NPI number — HENDRICKS COMMUNITY HOSPITAL

Table of content: (NPI 1316279755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316279755 NPI number — HENDRICKS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRICKS COMMUNITY 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:
HENDRICKS COUNTY WELLNESS CLINIC
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:
1316279755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
998 E MAIN ST STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-838-9355
Provider Business Mailing Address Fax Number:
317-718-2955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 E MAIN ST
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-1971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-718-2950
Provider Business Practice Location Address Fax Number:
317-718-2955
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RUMLEY
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
317-838-9355

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X , with the licence number:  090050051 , 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)





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