Healthcare Provider Details

I. General information

NPI: 1184348484
Provider Name (Legal Business Name): PERRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 STATE ROAD 237
TELL CITY IN
47586-8567
US

IV. Provider business mailing address

8885 STATE ROAD 237
TELL CITY IN
47586-8567
US

V. Phone/Fax

Practice location:
  • Phone: 812-772-0589
  • Fax:
Mailing address:
  • Phone: 812-772-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LEE HINTON
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential: AM
Phone: 812-772-0589