1598784175 NPI number — PARKVIEW WABASH HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598784175 NPI number — PARKVIEW WABASH HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKVIEW WABASH 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:
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:
1598784175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 N EAST ST
Provider Second Line Business Mailing Address:
P.O. BOX 548
Provider Business Mailing Address City Name:
WABASH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46992-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-569-2290
Provider Business Mailing Address Fax Number:
260-563-3625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 N EAST ST
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:
46992-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-569-2290
Provider Business Practice Location Address Fax Number:
260-563-3625
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BISSEL
Authorized Official First Name:
JANE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER FINANCE-COMMUNITY HOSPITAL
Authorized Official Telephone Number:
260-569-2247

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  003359 , 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: 100272960A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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