Healthcare Provider Details

I. General information

NPI: 1407847361
Provider Name (Legal Business Name): MAJOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST
WALDRON IN
46182-9791
US

IV. Provider business mailing address

505 N MAIN ST PO BOX 399
WALDRON IN
46182-9791
US

V. Phone/Fax

Practice location:
  • Phone: 765-525-4371
  • Fax: 765-525-4246
Mailing address:
  • Phone: 765-525-4371
  • Fax: 765-525-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050004231
License Number StateIN

VIII. Authorized Official

Name: MR. JOHN M HORNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 317-398-5252