Healthcare Provider Details

I. General information

NPI: 1659466498
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S MAIN ST
SUMMITVILLE IN
46070
US

IV. Provider business mailing address

1542 S. BLOOMINGTON STREET
GREENCASTLE IN
46135-2212
US

V. Phone/Fax

Practice location:
  • Phone: 765-536-2261
  • Fax: 765-536-4908
Mailing address:
  • Phone: 765-301-7525
  • Fax: 765-301-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060003731
License Number StateIN

VIII. Authorized Official

Name: DENNIS A. WEATHERFORD
Title or Position: CEO
Credential:
Phone: 765-301-7300