Healthcare Provider Details

I. General information

NPI: 1841215985
Provider Name (Legal Business Name): WELLSTONE REGIONAL HOSPITAL ACQUISITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VISSING PARK RD
JEFFERSONVILLE IN
47130-5989
US

IV. Provider business mailing address

2700 VISSING PARK RD
JEFFERSONVILLE IN
47130-5989
US

V. Phone/Fax

Practice location:
  • Phone: 812-284-8000
  • Fax: 812-704-1221
Mailing address:
  • Phone: 812-284-8000
  • Fax: 812-704-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number61100451A
License Number StateIN

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SRVP CFO
Credential:
Phone: 610-768-3300