Healthcare Provider Details

I. General information

NPI: 1952412546
Provider Name (Legal Business Name): JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 W TIPTON ST
SEYMOUR IN
47274-8659
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-6405
  • Fax: 812-523-6066
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-003342-1
License Number StateIN

VIII. Authorized Official

Name: DEBBIE RIDLEN
Title or Position: VP FISCAL SERVICES
Credential:
Phone: 812-522-0170