Healthcare Provider Details

I. General information

NPI: 1154321099
Provider Name (Legal Business Name): JOHNSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W JEFFERSON ST STE 202
FRANKLIN IN
46131-2732
US

IV. Provider business mailing address

PO BOX 800
FRANKLIN IN
46131-0800
US

V. Phone/Fax

Practice location:
  • Phone: 317-738-7878
  • Fax: 317-738-7872
Mailing address:
  • Phone: 317-738-7878
  • Fax: 317-738-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number005001
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number005001
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number005001
License Number StateIN

VIII. Authorized Official

Name: LARREL I DAILEY
Title or Position: DIRECTOR,REVENUE CYCLE
Credential:
Phone: 317-736-3588