Healthcare Provider Details

I. General information

NPI: 1316957814
Provider Name (Legal Business Name): HANCOCK REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL SQ STE 100
GREENFIELD IN
46140-2819
US

IV. Provider business mailing address

156 W MUSKEGON DR
GREENFIELD IN
46140-3069
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-3255
  • Fax:
Mailing address:
  • Phone: 317-468-6221
  • Fax: 317-468-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MUCKERHEIDE
Title or Position: CONTROLLER
Credential:
Phone: 317-468-6236