Healthcare Provider Details

I. General information

NPI: 1740466770
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 EAST JACKSON STREET
MUNCIE IN
47303-4467
US

IV. Provider business mailing address

4600 EAST JACKSON STREET
MUNCIE IN
47303-4467
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-1416
  • Fax: 765-289-7190
Mailing address:
  • Phone: 765-282-1416
  • Fax: 765-289-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070002693
License Number StateIN

VIII. Authorized Official

Name: MR. GREGG MALOTT
Title or Position: CONSULTANT
Credential:
Phone: 574-946-2100