Healthcare Provider Details

I. General information

NPI: 1982710943
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7476 W LANE RD.
MCCORDSVILLE IN
46055-9506
US

IV. Provider business mailing address

7476 W LANE RD.
MCCORDSVILLE IN
46055-9506
US

V. Phone/Fax

Practice location:
  • Phone: 317-335-2159
  • Fax: 317-335-3325
Mailing address:
  • Phone: 317-335-2159
  • Fax: 317-335-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060004771
License Number StateIN

VIII. Authorized Official

Name: GREGG A MALOTT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 574-946-2103