Healthcare Provider Details

I. General information

NPI: 1396783239
Provider Name (Legal Business Name): FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 STATE ROAD 64 FLOYD MEMORIAL FAMILY MEDICINE
GEORGETOWN IN
47122-9178
US

IV. Provider business mailing address

3844 RELIABLE PARKWAY FLOYD MEMORIAL FAMILY MEDICINE
CHICAGO IL
60686-0038
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-4200
  • Fax: 812-923-4203
Mailing address:
  • Phone: 812-949-5482
  • Fax: 812-949-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD W. MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 812-949-5500