Healthcare Provider Details

I. General information

NPI: 1417398199
Provider Name (Legal Business Name): JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WINDY HILL DR
LAFAYETTE IN
47905-2862
US

IV. Provider business mailing address

300 WINDY HILL DR
LAFAYETTE IN
47905-2862
US

V. Phone/Fax

Practice location:
  • Phone: 765-477-7791
  • Fax: 765-474-6083
Mailing address:
  • Phone: 765-477-7791
  • Fax: 765-474-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC DUANE FISH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 812-523-5864