Healthcare Provider Details

I. General information

NPI: 1336571538
Provider Name (Legal Business Name): WABASH COUNTY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N EAST ST
WABASH IN
46992-1914
US

IV. Provider business mailing address

710 N EAST ST
WABASH IN
46992-1914
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-3131
  • Fax: 260-569-2410
Mailing address:
  • Phone: 260-563-3131
  • Fax: 260-569-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE MARIE BISSEL
Title or Position: CFO
Credential:
Phone: 260-569-2247