Healthcare Provider Details

I. General information

NPI: 1205839826
Provider Name (Legal Business Name): JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E RACE ST
ODON IN
47562-1425
US

IV. Provider business mailing address

601 E RACE ST
ODON IN
47562-1425
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-4920
  • Fax: 812-636-4763
Mailing address:
  • Phone: 812-636-4920
  • Fax: 812-636-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050003001
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: KATHY ANN WITTMER
Title or Position: ADMINISTRATOR
Credential: H.F.A.
Phone: 812-636-4920