Healthcare Provider Details

I. General information

NPI: 1083888200
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

V. Phone/Fax

Practice location:
  • Phone: 765-301-7600
  • Fax: 765-655-2648
Mailing address:
  • Phone: 765-301-7600
  • Fax: 765-301-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number60000766A
License Number StateIN

VIII. Authorized Official

Name: DR. MARY BETH KAISER
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 765-301-7602