Healthcare Provider Details

I. General information

NPI: 1659366128
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 W STATE ROAD 46
BLOOMINGTON IN
47404-9359
US

IV. Provider business mailing address

1050 CHINOE RD SUITE 350
LEXINGTON KY
40502-6571
US

V. Phone/Fax

Practice location:
  • Phone: 812-876-6400
  • Fax: 812-876-1122
Mailing address:
  • Phone: 859-255-0075
  • Fax: 859-281-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040005581
License Number StateIN

VIII. Authorized Official

Name: BRENDA CAMPBELL
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 859-255-0075