=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073639936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENDRICKS REGIONAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 09/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 E MAIN STREET
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-745-9531
-----------------------------------------------------
Fax | 317-745-9534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 E MAIN STREET
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-745-9531
-----------------------------------------------------
Fax | 317-745-9534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO OF HENDRICKS REGIONAL
-----------------------------------------------------
Name | DENNIS W. DAWES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-745-9530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1255404455/71002313A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 72000117B/72000005B
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 101037731A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------