Healthcare Provider Details

I. General information

NPI: 1629143037
Provider Name (Legal Business Name): JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

IV. Provider business mailing address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-2349
  • Fax: 812-522-0792
Mailing address:
  • Phone: 812-522-2349
  • Fax: 812-522-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number005330
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005330
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005330
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number005330
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number005330
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number005330
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005330
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005330
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number005330
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number005330
License Number StateIN
# 11
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number005330
License Number StateIN
# 12
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number005330
License Number StateIN

VIII. Authorized Official

Name: MRS. DEBORAH MANN
Title or Position: VP FINANCE AND CFO/TREASURER
Credential:
Phone: 812-522-2349