Healthcare Provider Details

I. General information

NPI: 1528626652
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S PEARL ST
KNOX IN
46534-1416
US

IV. Provider business mailing address

PO BOX 279
WINAMAC IN
46996-0279
US

V. Phone/Fax

Practice location:
  • Phone: 574-207-5050
  • Fax:
Mailing address:
  • Phone: 574-946-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGG MALOTT
Title or Position: CFO
Credential:
Phone: 574-946-2103