1790863835 NPI number — THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC

Table of content: (NPI 1790863835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790863835 NPI number — THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LITTLE COMPANY OF MARY HOSPITAL OF INDIANA, 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:
1790863835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1028
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47547-1028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-481-8483
Provider Business Mailing Address Fax Number:
812-481-8497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 W 13TH ST
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47546-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-482-0626
Provider Business Practice Location Address Fax Number:
812-482-0650
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNOWDEN
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
812-482-2345

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB1118 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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