Healthcare Provider Details

I. General information

NPI: 1679921035
Provider Name (Legal Business Name): DAVIESS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEMORIAL AVE STE C
WASHINGTON IN
47501-3154
US

IV. Provider business mailing address

PO BOX 760
WASHINGTON IN
47501-0760
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2760
  • Fax: 812-254-8636
Mailing address:
  • Phone: 812-254-2760
  • Fax: 812-254-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16-005056-1
License Number StateIN

VIII. Authorized Official

Name: MR. ANTHONY SHOWALTER
Title or Position: BOARD PRESIDENT
Credential:
Phone: 812-254-2760