Healthcare Provider Details

I. General information

NPI: 1306141163
Provider Name (Legal Business Name): HENDRICKS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 E US HIGHWAY 36
BAINBRIDGE IN
46105-9604
US

IV. Provider business mailing address

1100 SOUTHFIELD DR SUITE 1370
PLAINFIELD IN
46168-4498
US

V. Phone/Fax

Practice location:
  • Phone: 765-522-1889
  • Fax: 765-522-3583
Mailing address:
  • Phone: 317-837-5571
  • Fax: 317-837-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RUTHERFORD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 317-837-5566