Healthcare Provider Details

I. General information

NPI: 1548506363
Provider Name (Legal Business Name): THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 W MAIN ST
VEVAY IN
47043
US

IV. Provider business mailing address

1023 W MAIN ST
VEVAY IN
47043-9192
US

V. Phone/Fax

Practice location:
  • Phone: 812-427-2803
  • Fax: 812-427-2646
Mailing address:
  • Phone: 812-427-2803
  • Fax: 812-427-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100291320A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: STEVE VAN CAMP
Title or Position: CFO OF ASC
Credential: CPA
Phone: 317-788-2500