Healthcare Provider Details

I. General information

NPI: 1881632800
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12999 N PENNSYLVANIA ST
CARMEL IN
46032-5477
US

IV. Provider business mailing address

12999 N. PENNSYLVANIA ST.
CARMEL IN
46032-5477
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-2448
  • Fax: 317-848-5990
Mailing address:
  • Phone: 317-848-2448
  • Fax: 317-848-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-001149-1
License Number StateIN

VIII. Authorized Official

Name: MR. GREGG A. MALOTT
Title or Position: CFO
Credential:
Phone: 574-946-2100