1982930483 NPI number — JASPER COUNTY HOSPITAL

Table of content: (NPI 1982930483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982930483 NPI number — JASPER COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASPER COUNTY 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:
JASPER COUNTY HOSPITAL DEMOTTE MEDICAL EQUIPMENT
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:
1982930483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1104 E GRACE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENSSELAER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47978-3296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-866-5141
Provider Business Mailing Address Fax Number:
219-866-2014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S HALLECK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMOTTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46310-8630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-987-6762
Provider Business Practice Location Address Fax Number:
219-987-6763
Provider Enumeration Date:
10/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official Telephone Number:
219-866-5141

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200357640A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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