Healthcare Provider Details

I. General information

NPI: 1629066790
Provider Name (Legal Business Name): WITHAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 E 136TH ST
CARMEL IN
46033-9402
US

IV. Provider business mailing address

6401 S US HIGHWAY 41
TERRE HAUTE IN
47802-4749
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-0265
  • Fax: 317-846-3944
Mailing address:
  • Phone: 812-298-3002
  • Fax: 812-298-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number04-000545-1
License Number StateIN

VIII. Authorized Official

Name: KELLY BRAVERMAN
Title or Position: CEO, PRESIDENT
Credential:
Phone: 765-485-8100