Healthcare Provider Details

I. General information

NPI: 1659435592
Provider Name (Legal Business Name): WOODLAWN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E 9TH ST
ROCHESTER IN
46975
US

IV. Provider business mailing address

1400 E 9TH ST
ROCHESTER IN
46975-8931
US

V. Phone/Fax

Practice location:
  • Phone: 574-223-9393
  • Fax: 574-223-5847
Mailing address:
  • Phone: 574-223-3141
  • Fax: 574-224-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KRAFT
Title or Position: CFO
Credential:
Phone: 574-224-1118