Healthcare Provider Details

I. General information

NPI: 1376601559
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E US HIGHWAY 36
BAINBRIDGE IN
46105-9608
US

IV. Provider business mailing address

440 E US HIGHWAY 36
BAINBRIDGE IN
46105-9608
US

V. Phone/Fax

Practice location:
  • Phone: 765-522-2556
  • Fax: 765-522-2560
Mailing address:
  • Phone: 765-522-2556
  • Fax: 765-522-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA LEE MESCALL
Title or Position: ACCOUNTANT
Credential:
Phone: 765-655-2576