Healthcare Provider Details

I. General information

NPI: 1235294075
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S MURPHY AVE
BRAZIL IN
47834-8316
US

IV. Provider business mailing address

501 S MURPHY AVE
BRAZIL IN
47834-8316
US

V. Phone/Fax

Practice location:
  • Phone: 812-446-2636
  • Fax: 812-448-2537
Mailing address:
  • Phone: 812-446-2363
  • Fax: 812-446-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05 000514 1
License Number StateIN

VIII. Authorized Official

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