Healthcare Provider Details

I. General information

NPI: 1376540310
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E. 13TH STREET
WINAMAC IN
46996-1117
US

IV. Provider business mailing address

616 E. 13TH STREET PO BOX 279
WINAMAC IN
46996-1117
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-2140
  • Fax: 574-946-2128
Mailing address:
  • Phone: 574-946-2140
  • Fax: 574-946-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number005285
License Number StateIN

VIII. Authorized Official

Name: MRS. VICKIE A WHITE
Title or Position: DIRECTOR
Credential: RN
Phone: 574-946-2146