1346263217 NPI number — PULASKI MEMORIAL HOSPITAL

Table of content: (NPI 1346263217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346263217 NPI number — PULASKI MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULASKI 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:
SIMMONS LOVING CARE HEALTH FACILITY
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:
1346263217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 E 21ST AVE
Provider Second Line Business Mailing Address:
P.O. BOX 1678
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46407-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-882-2563
Provider Business Mailing Address Fax Number:
219-882-2616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E 21ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-882-2563
Provider Business Practice Location Address Fax Number:
219-882-2616
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALOTT
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIR. OF BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
574-946-2100

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  05-000368-1 , 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: 100275220A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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