Healthcare Provider Details

I. General information

NPI: 1457317786
Provider Name (Legal Business Name): JASPER COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 S BIERMA ST
WHEATFIELD IN
46392
US

IV. Provider business mailing address

1104 E GRACE ST
RENSSELAER IN
47978-3211
US

V. Phone/Fax

Practice location:
  • Phone: 219-956-2110
  • Fax: 219-956-3548
Mailing address:
  • Phone: 219-866-5141
  • Fax: 219-866-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001593A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000809A
License Number StateIN

VIII. Authorized Official

Name: JEFFREY D WEBB
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 219-866-5141