Healthcare Provider Details

I. General information

NPI: 1417015884
Provider Name (Legal Business Name): DAVIESS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12546 E US HIGHWAY 50
LOOGOOTEE IN
47553-5220
US

IV. Provider business mailing address

12546 E US HIGHWAY 50
LOOGOOTEE IN
47553-5220
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-5095
  • Fax: 812-295-9403
Mailing address:
  • Phone: 812-295-5095
  • Fax: 812-295-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number02000751A
License Number StateIN

VIII. Authorized Official

Name: ANTHONY SHOWALTER
Title or Position: BOARD MEMEBER
Credential:
Phone: 812-254-8620