Healthcare Provider Details

I. General information

NPI: 1932315264
Provider Name (Legal Business Name): WOODLAWN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 9TH ST
ROCHESTER IN
46975-8931
US

IV. Provider business mailing address

1400 E 9TH ST
ROCHESTER IN
46975-8931
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01046904
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051336
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01038921
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01044502
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049343
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01042718
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000786
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000682
License Number StateIN
# 9
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01031969
License Number StateIN

VIII. Authorized Official

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