Healthcare Provider Details

I. General information

NPI: 1669795985
Provider Name (Legal Business Name): JAY COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 W VOTAW ST SUITE A
PORTLAND IN
47371-1302
US

IV. Provider business mailing address

428 W VOTAW ST SUITE A
PORTLAND IN
47371-1302
US

V. Phone/Fax

Practice location:
  • Phone: 260-726-8822
  • Fax: 260-726-7857
Mailing address:
  • Phone: 260-726-8822
  • Fax: 260-726-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DON MICHAEL
Title or Position: CFO
Credential:
Phone: 260-726-1818