Healthcare Provider Details

I. General information

NPI: 1598826752
Provider Name (Legal Business Name): WASHINGTON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SPRING MEADOW CIR
SALEM IN
47167-9429
US

IV. Provider business mailing address

125 SPRING MEADOW CIR
SALEM IN
47167-9429
US

V. Phone/Fax

Practice location:
  • Phone: 812-883-3963
  • Fax:
Mailing address:
  • Phone: 812-883-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number01058910A
License Number StateIN

VIII. Authorized Official

Name: ABDELRAHMAN M ABDALLA
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 812-883-5881