MEDICARE: PULASKI MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	15-010996-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497792345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULASKI MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	701 HENRY ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1095
Country	:	US
Telephone Number	:	812-346-9333
Fax Number	:	812-352-0011

Provider Business Practice Location Address
First Line	:	701 HENRY ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1095
Country	:	US
Telephone Number	:	812-346-9333
Fax Number	:	812-352-0011

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	GREGG A MALOTT
Credential	:
Telephone Number	:	574-946-2103

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	05/11/2026

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Directions to “PULASKI MEMORIAL HOSPITAL ” Practice Location

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