Healthcare Provider Details

I. General information

NPI: 1720017510
Provider Name (Legal Business Name): PULASKI MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 13TH ST
WINAMAC IN
46996-1144
US

IV. Provider business mailing address

515 E 13TH ST
WINAMAC IN
46996-1144
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-6143
  • Fax: 574-946-6186
Mailing address:
  • Phone: 574-946-6143
  • Fax: 574-946-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000414-2
License Number StateIN

VIII. Authorized Official

Name: GREGG A MALOTT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 574-946-2103