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	05-00056301	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	000000556877	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1811987894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULASKI MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	643 WEST UTICA STREET
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-1163
Country	:	US
Telephone Number	:	812-246-4866
Fax Number	:	821-246-3925

Provider Business Practice Location Address
First Line	:	643 WEST UTICA STREET
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-1163
Country	:	US
Telephone Number	:	812-246-4866
Fax Number	:	821-246-3925

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS DEVELOPMENT
Name	:	MR. GREGG A. MALOTT
Credential	:
Telephone Number	:	574-946-2100

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/16/2019

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Directions to “PULASKI MEMORIAL HOSPITAL ” Practice Location

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